Hospital Discounted Care

Page Updated: Oct. 10, 2024

CHA Advocacy Principle: Reforms should support affordability through transparency, accountability, and shared responsibility, including from state agencies implementing legislation.

What Has Been Completed:

Origin: House Bill 21-1198, which went into effect Sept. 1, 2022, codifies charity care laws and establishes requirements for how hospitals screen, bill, and collect payments from low-income patients.

Background: The rules govern the process for how hospitals screen, bill, and collect payments from low-income patients. They cover any medically necessary services provided in acute care and critical access hospitals, as well as freestanding emergency departments.

CHA led passage of SB 24-116 to make five key changes to Hospital Discounted Care: 

    1. Medicaid: The bill allows all hospitals to serve as presumptive eligibility sites to get patients temporary coverage. Currently, patients who are eligible for Medicaid, but not enrolled, do not have an expedited pathway to gain access to coverage or a requirement to apply. HCPF will conduct training for hospitals that wish to become presumptive eligibility sites starting in fiscal year 2026-27. 
    1. Physician Reporting: The bill removes hospitals from an inappropriate middleman role aligning reporting requirements for physicians. 
    1. Inconsistent Billing Caps: The bill allows hospitals to bill up to 6% of a patient’s gross monthly income when the hospital is billing on behalf of physicians. Current law allows hospitals to bill up to 4% and physicians up to 2%, consistent with the HDC fee schedule. However, this structure doesn’t effectively recognize instances where the hospital bills on behalf of an employed physician. 
    1. Scope of Hospital Services: The bill excludes primary care provided in rural health clinics from HDC. Current law applies to all services under the hospital’s license, which inappropriately includes many services outside of the scope of HDC. 
    1. Colorado Residency: The bill clarifies that an individual must attest to residing in Colorado to be eligible for HDC. This change codifies current practice. 

These changes went into effect Aug. 1, 2024. CHA will help support with implementing these changes. 

Outstanding Items:

SB 24-116 also included a provision to support hospitals’ ability to become presumptive eligibility sites for Medicaid. There will be a stakeholder process to develop those policies in 2025 with implementation in 2026.  

Resources: 

Meetings/Dates of Note:

    • Every Other Wednesday: HCPF Office Hours: 9 – 10 a.m. (Zoom link here)
    • Sept. 1: Data reporting template due

CHA Staff Contact: Megan Axelrod, CHA senior director of regulatory policy and federal affairs, [email protected]