(1) On and after January 1, 2020, health care facilities shall develop and provide disclosures to consumers about the potential effects of receiving emergency or nonemergency services from an out-of-network provider providing services at an in-network facility or emergency services at an out-of-network facility. The disclosures must comply with the rules adopted pursuant to subsection (2) of this section.
(2) The state board of health, in consultation with the commissioner of insurance and the director of the division of professions and occupations in the department of regulatory agencies, shall adopt rules that specify the requirements for health care facilities to develop and provide consumer disclosures in accordance with this section. The state board of health shall ensure that the rules are consistent with sections 10-16-704 (12) and 12-30-112 and rules adopted by the commissioner pursuant to section 10-16-704 (12)(b) and by the director of the division of professions and occupations pursuant to section 12-30-112 (3). The rules must specify, at a minimum, the following:
The timing for providing the disclosures for emergency and nonemergency serviceswith consideration given to potential limitations relating to the federal "Emergency Medical Treatment and Labor Act", 42 U.S.C. sec. 1395dd;
Requirements regarding how the disclosures must be made, including requirementsto include the disclosures on billing statements, billing notices, or other forms or communications with covered persons;
The contents of the disclosures, including the consumer's rights and payment obligations pursuant to the consumer's health benefit plan;
Disclosure requirements specific to health care facilities, including whether a healthcare provider delivering services at the facility is out of network, the types of services an out-ofnetwork health care provider may provide, and the right to request an in-network health care provider to provide services; and
Requirements concerning the language to be used in the disclosures, including use ofplain language, to ensure that carriers, health care facilities, and health care providers use language that is consistent with the disclosures required by this section and sections 10-16-704 (12) and 12-30-112 and the rules adopted pursuant to this subsection (2) and sections 10-16-704
(12)(b) and 12-30-112 (3).
Receipt of the disclosure required by this section does not waive a consumer's protections under section 10-16-704 (3) or (5.5) or the consumer's right to benefits under the consumer's health benefit plan at the in-network benefit level for all covered services and treatment received.
For the purposes of this section and section 25-3-122:
"Carrier" has the same meaning as defined in section 10-16-102 (8).
"Covered person" has the same meaning as defined in section 10-16-102 (15).
"Emergency services" has the same meaning as defined in section 10-16-704
(5.5)(e)(II).
"Geographic area" has the same meaning as defined in section 10-16-704
(3)(d)(VI)(A).
"Health benefit plan" has the same meaning as defined in section 10-16-102 (32).
"Medicare reimbursement rate" has the same meaning as defined in section 10-16704 (3)(d)(VI)(B).
"Out-of-network facility" means a health care facility that is not a participating provider, as defined in section 10-16-102 (46).
Source: L. 2019: Entire section added, (HB 19-1174), ch. 171, p. 1992, § 6, effective January 1, 2020.