Colorado § 10-16-1303 - Definitions.

§ 10-16-1303. Definitions.

As used in this part 13, unless the context otherwise requires:

(1) "Advisory board" means the board established in section 10-16-1307.

(2) "Critical access hospital" means a hospital that is federally certified or undergoing federal certification as a critical access hospital pursuant to 42 CFR 485, subpart F.

(3) (a) "Equivalent rate" means, for a hospital that is part of a pediatric specialty hospital system where over ninety percent of the hospital system's population served is under eighteen years of age and that has a level one pediatric trauma center, the payment rate determined by the medicaid fee schedule for the hospital from the most recent year for which a complete set of hospital financial data is publicly available as of May 10, 2023, multiplied by a conversion factor equal to the ratio of the statewide payment-to-cost ratio for medicare to the hospital's specific payment-to-cost ratio for the most recent set of publicly available hospital financial data as of May 10, 2023, which is 1.52.

(b) In any given year, the rate in subsection (3)(a) of this section must be adjusted annually for cumulative inflation by a factor equal to the average percentage increase in the medicare inpatient and outpatient prospective payment systems over the previous three years.

(c) For any health-care service without an existing medicare reimbursement rate and for services that have low volume statewide relative to other medicare services, including pediatric or obstetric services, an equivalent rate means a rate set by rule of the commissioner after consultation with a statewide association of hospitals, physicians, other providers, and the department of health care policy and financing. The equivalent rate must utilize the ratio of medicaid payment rates to existing medicare payment rates whenever possible.

(4) "Essential access hospital" means a critical access hospital or general hospital located in a rural area with twenty-five or fewer licensed beds.

(5) "Essential community provider" has the same meaning as set forth in section 25.5-8-103 (6).

(6) "General hospital" means a hospital licensed as a general hospital by the Colorado department of public health and environment.

(7) "Health-care coverage cooperative" has the same meaning as set forth in section 10-16-1002 (2).

(8) "Health-care provider" means a health-care professional registered, certified, or licensed pursuant to title 12 or a health facility licensed or certified pursuant to section 25-1.5-103.

(9) "Health system" means a corporation or other organization that owns, contains, or operates three or more hospitals.

(10) "Medical inflation" means the annual percentage change in the medical care index component of the United States department of labor's bureau of labor statistics consumer price index for medical care services and medical care commodities for the Denver-Aurora-Lakewood area, or its applicable predecessor or successor index, based on the average change in the medical care index over the previous three years.

(11) (a) "Medicare reimbursement rate" means the facility-specific reimbursement rate for a particular health-care service provided under the "Health Insurance for the Aged Act", Title XVIII of the federal "Social Security Act", 42 U.S.C. sec. 1395 et seq., as amended.

(b) For a hospital that is reimbursed through the medicare prospective payments systems rate for a critical access hospital, "medicare reimbursement rate" means the rate based on allowable costs as reported in medicare cost reports and the historical cost-to-charge ratios for the specific hospital.

(12) "Public benefit corporation" means a public benefit corporation formed pursuant to part 5 of article 101 of title 7 that may be organized and operated by the exchange pursuant to section 10-22-106 (3).

(13) "Small group market" means the market for small group sickness and accident insurance.

(14) "Standardized plan" means the standardized health benefit plan designed by rule of the commissioner pursuant to section 10-16-1304.

Source: L. 2021: Entire part added, (HB 21-1232), ch. 241, p. 1279, § 1, effective June 16. L. 2023: (3)(a) and (10) amended, (HB 23-1224), ch. 159, p. 689, § 1, effective May 10.