HOUSE 3rd Reading Unamended May 4, 2016 HOUSE Amended 2nd Reading May 3, 2016Second Regular Session Seventieth General Assembly STATE OF COLORADO REENGROSSED This Version Includes All Amendments Adopted in the House of Introduction LLS NO. 16-0824.01 Christy Chase x2008 HOUSE BILL 16-1374 HOUSE SPONSORSHIP McCann, Esgar, Ginal, Lontine, Primavera, Ryden SENATE SPONSORSHIP Kefalas, House Committees Senate Committees Health, Insurance, & Environment A BILL FOR AN ACT Concerning disclosure requirements applicable to a licensed community clinic providing emergency services to patients at a site that is not attached to a hospital. Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://www.leg.state.co.us/billsummaries.) The bill requires a freestanding emergency room that provides emergency services in a facility, charges a facility fee, and is not attached to a hospital to post notices throughout the facility indicating that the facility is an emergency room that provides emergency services to treat emergency medical conditions. Additionally, a freestanding emergency room, after performing an initial medical examination, must inform a patient who is determined not to have an emergency medical condition of, and provide to the patient a written statement containing, the following information: That the freestanding emergency room charges rates comparable to those charged by a hospital emergency room, including a facility fee of a specified amount; That the freestanding emergency room or a physician providing medical care at the center may not be a participating provider under the patient's health benefit plan; That the physician providing medical care at the freestanding emergency room may bill the patient separately from the center; and That for nonemergency medical conditions, the patient may wish to confer with his or her primary care physician or other primary care provider. The freestanding emergency room must explain the contents of the written statement to the patient, obtain the patient's signature on the document, provide the patient with a copy of the signed document, and maintain the signed document in the patient's medical record. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. In Colorado Revised Statutes, add 25-3-117 as follows: 25-3-117. Freestanding emergency rooms - stakeholder group study - report - legislative declaration - repeal. (1) The general assembly hereby finds and declares that: (a) Emergency services are crucial to Colorado communities, providing care when Coloradans are in critical need; (b) Emergency care is not a substitute for primary care, and patients with nonemergent conditions may be more appropriately served in a primary care and less costly setting; (c) Individuals should be able to make informed decisions about accessing health care services of their choice without barriers or restrictions; (d) It is in the public interest for health care consumers to receive balanced and complete information about their rights and responsibilities with regard to emergency services; and (e) In order to determine the appropriate manner in which to provide balanced and complete information to consumers without discouraging consumers from seeking the care they need, it is important to obtain input from all stakeholders involved in the delivery and receipt of and payment for emergency services, as well as state and federal government agencies tasked with ensuring compliance with applicable state and federal laws. (2) (a) The executive director of the department or his or her designee shall convene a stakeholder group to address, at a minimum, the following: (I) Public education about primary care, urgent care, and emergency care; (II) Signs and notifications that comply with EMTALA, as determined through collaboration and consultation with the federal centers for medicare and medicaid services; (III) Appropriate regulation of freestanding emergency rooms; (IV) Definitions of freestanding emergency rooms and urgent care facilities; (V) Consideration of implementing a certificate of need program; (VI) Future projections for neighborhood or community health care needs; (VII) Costs and fees, including facility fees, associated with medical care provided at a freestanding emergency room; and (VIII) Other matters the executive director or the stakeholder group deems necessary to facilitate the delivery of thorough information about available health care services and costs to health care consumers. (b) (I) The executive director shall appoint to the stakeholder group representatives from or of at least the following: (A) The department; (B) The division of insurance in the department of regulatory agencies; (C) A statewide organization representing hospitals; (D) A hospital system that operates a freestanding emergency room; (E) A statewide organization representing emergency room physicians; (F) A statewide organization representing physicians; (G) A statewide organization representing family physicians; (H) A medicaid accountable care provider; (I) Two statewide organizations representing health care consumers; (J) Two individual consumers who have visited a freestanding emergency room; (K) An independent freestanding emergency room that is not owned or operated by a hospital system, if one exists or is planned in Colorado; (L) Two carriers that issue health benefit plans in Colorado; (M) One community health center; and (N) One large and one small business. (II) The executive director shall also appoint an independent EMTALA expert to serve on the stakeholder group. (c) The executive director shall convene the first meeting with the stakeholders no later than August 1, 2016, and as needed thereafter. (d) By January 1, 2017, the executive director of the department or his or her designee shall prepare and submit a progress report to the health and human services committee of the senate and the health, insurance, and environment and public health care and human services committees of the house of representatives, or their successor committees. By March 1, 2017, the executive director or his or her designee shall submit a final report to the specified legislative committees containing the findings and conclusions of the study, which may include legislative and administrative recommendations to address the issues studied by the stakeholder group. (3) As used in this section: (a) "Department" means the department of public health and environment. (b) "EMTALA" means the federal "Emergency Medical Treatment and Active Labor Act", 42 U.S.C. sec. 1395dd, and regulations adopted under the act. (c) (I) "Freestanding emergency room" means a community clinic licensed by the department of public health and environment pursuant to section 25-3-101 that: (A) Offers emergency services; (B) Charges a facility fee; and (C) Is not attached to or contained within a hospital. (II) The term includes a health facility licensed or certified by the department of public health and environment pursuant to section 25-3-101 that: (A) Offers emergency services; (B) Charges a facility fee; and (C) Is affiliated with or operated by a hospital system and is located off the hospital's main campus. (III) The term excludes a licensed community clinic that provides emergency services and urgent care services within the same location and charges differential rates for the emergency services and urgent care services it provides. (4) This section is repealed, effective July 1, 2017. SECTION 2. Safety clause. The general assembly hereby finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, and safety.