HB21-1198 Health Care Billing Requirements for Indigent Patients
During the 2021 Colorado General Assembly session, House Bill 21-1198, otherwise known as Health Care Billing Requirements for Indigent Patients, was passed. This bill creates a safety net program for low-income patients at every hospital and free-standing emergency room, including all health care professionals who work within those facilities.
Under this bill, care received at a hospital or free-standing emergency room will be capped at no more than the higher of the Medicaid or Medicare rate for that service. These rates will be set by the Department. Payment plans that are established to cover these bills may not exceed 4% of the patient's household income for the facility charge and 2% of the household income for each health-care professional. Additionally, once a patient has paid the equivalent of 36 payments on their established plan, the remainder of their bill is forgiven.
House Bill 21-1198 mandates that all uninsured patients must be screened for eligibility for Health First Colorado, the Child Health Plan Plus (CHP+), Medicare, Emergency Medicaid, the Colorado Indigent Care Program (CICP), and discounted health care as described within the bill. Uninsured patients must be screened or formally waive their screening. Insured patients may request to be screened. Additionally, the financial screenings for the program created under this legislation must be completed using a uniform application, which will be created by the Department.
Unlike CICP, the program created by HB 21-1198 applies to all Colorado hospitals and free-standing emergency rooms, as well as all health care professionals working within those facilities. Under this legislation, hospitals will look at income only and no liquid resources or other assets will be considered. This legislation applies to all services at the hospital whereas CICP only mandates that emergency services be discounted.
The Department has convened a Policy Development Team that will aid in providing insights into the impact of changes on operations and outcomes, both intended and unintended, proposing changes to policy language and form design and content and determining how to best integrate feedback from stakeholders.
Rules for HB21-1198 will be presented to the Medical Services Board for approval in March 2022. Stakeholder meetings will be held in January and will be announced through this Constant Contact email list and on the Hospital Discounted Care webpage. The program has an effective date of June 1, 2022 per the bill. More information is on the Department's Hospital Discounted Care webpage, and questions can be sent to
Afghan Humanitarian Parolees
A Continuing Resolution was signed on Sept. 30, 2021, providing for Afghan evacuees, SIV holders, SI/SQ Parolees, and Humanitarian Parolees arriving in the US between July 31, 2021 and Sept. 30, 2022 to be exempted from the five-year bar and immediately eligible for Medicaid, assuming they are otherwise eligible. Afghan Humanitarian Parolees include citizens or nationals arriving from Afghanistan between the previously mentioned dates. If any children, spouses, and/or legal guardians of an individual arriving between July 31, 2021 and Sept. 30, 2022 arrive after that date, they will also be considered qualified non-citizens not subject to the five-year bar. These individuals will be screened for Health First Colorado, CHP+, and Refugee Medical Assistance. They may also be eligible to purchase health care through Connect for Health Colorado.
The Department is working on corresponding system changes, policy rule updates, and a policy/operational memo for eligibility workers to provide coverage. As such, these populations will only be eligible for CICP if they have a household income over the Health First Colorado limits. Ineligibility code B should NOT be used for these populations since they are not subject to the five-year bar.
Monoclonal Antibody Treatments
Monoclonal antibody treatments are becoming more common in efforts to keep high-risk patients out of hospitals if they test positive for or begin feeling sick after being exposed to COVID-19. These treatments are allowable under CICP as they have emergency use authorization from the FDA. Remaining charges for treatments after any third party reimbursement and client co-payment are allowed to be included in write-offs for the program. These treatments would be considered a specialty outpatient procedure and would fall under that category for co-pay determination. If receiving reimbursement through a third party prohibits co-payment responsibilities for the patient, then no co-pay may be charged to the CICP client receiving the treatment. Information about the treatments as well as FAQs and a map showing where the treatments are available is available on the Department of Public Health & Environment State Emergency Operations Center website.
Open Enrollment
It is officially open enrollment season, for both private plans through Connect for Health Colorado and Medicare. Providers should be encouraging eligible seniors to apply for Medicare, as not applying as soon as they are eligible may result in higher fees and penalties for them in the future. Not applying may also cause them to fall into the gap where they cannot be covered by Medicare, Health First Colorado, or CICP until the next open enrollment session. Open enrollment information that can be shared with clients is on the Department's website. The webpage should print out nicely for physical handouts as well.
