Colorado § 25-3-101 - Hospitals - health facilities - licensed - definitions.

§ 25-3-101. Hospitals - health facilities - licensed - definitions.

(1) It is unlawful for any person, partnership, association, or corporation to open, conduct, or maintain any general hospital; hospital unit; freestanding emergency department as defined in section 25-1.5-114; critical access hospital as defined in section 25-1.5-114.5; psychiatric hospital; community clinic; rehabilitation hospital; convalescent center; facility for persons with developmental disabilities as defined in section 25-1.5-103 (2)(c); nursing care facility; hospice care; assisted living residence, except an assisted living residence shall be assessed a license fee as set forth in section 25-27-107; dialysis treatment clinic; ambulatory surgical center; birthing center; home care agency; or other facility of a like nature, except those wholly owned and operated by a governmental unit or agency, without first having obtained a license from the department.

(2) As used in this section, unless the context otherwise requires:

(a) (I) "Community clinic" means a health-care facility that provides health-care services on an ambulatory basis, is neither licensed as an on-campus department or service of a hospital nor listed as an off-campus location under a hospital's license, and meets at least one of the following criteria:

(A) Operates inpatient beds at the facility for the provision of extended observation and other related services for not more than seventy-two hours;

(B) Provides emergency services at the facility and is not otherwise required to obtain licensure as a freestanding emergency department in accordance with section 25-1.5-114; or

(C) Is not otherwise subject to health facility licensure under this section or section 25-1.5-103 but opts to obtain licensure as a community clinic in order to receive private donations, grants, government funds, or other public or private reimbursement for services rendered.

(II) "Community clinic" includes a prison clinic operated by the department of corrections.

(III) "Community clinic" does not include:

(A) A federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4);

(B) A rural health clinic, as defined in section 1861 (aa)(2) of the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2);

(C) A facility that functions only as an office for the practice of medicine or the delivery of primary care services by other licensed or certified practitioners; or

(D) A freestanding emergency department, as defined in and required to be licensed under section 25-1.5-114.

(b) "Hospital unit" means a physical portion of a licensed or certified general hospital, psychiatric hospital, maternity hospital, or rehabilitation hospital that is leased or otherwise occupied pursuant to a contractual agreement by a person other than the licensee of the host facility for the purpose of providing outpatient or inpatient services.

(c) "Main hospital" means a health-care facility that is licensed as a general hospital and operates a remote psychiatric inpatient location under a general hospital's license.

(d) "Remote psychiatric inpatient location of a general hospital" or "remote psychiatric inpatient location" means a health-care facility that is federally determined or seeking federal determination as a remote location of a main hospital with provider-based status pursuant to 42 CFR 413.65, delivers health-care services under the name, ownership, and financial and administrative control of a main hospital, and meets the following criteria:

(I) (A) Was initially licensed by the department as a psychiatric hospital; or

(B) Would otherwise be subject to licensing as a psychiatric hospital;

(II) Meets all the state board of health licensing rules for a psychiatric hospital, including building standards adopted pursuant to section 25-1-108 (1)(c)(II);

(III) Is a standalone facility not located on any hospital campus;

(IV) Is located within thirty-five miles of the main hospital in a rural area as defined in section 25-1.5-103 (3)(b); and

(V) Offers primarily inpatient psychiatric services with seventeen or more inpatient beds.

(3) Nothing in this section shall be construed to require the licensing of individual services provided by a licensed or certified provider on its own premises.

(4) A health-care facility is not required to be licensed as a community clinic solely due to the facility's ownership status, corporate structure, or engagement of outside vendors to perform nonclinical management services. This section permits regulation of a physician's office only to the extent the office is a community clinic as defined in this section.

(5) A health-care facility that is a remote psychiatric inpatient location of a general hospital is not required to be separately licensed as a psychiatric hospital. The department shall recognize the health-care facility as lawfully licensed under the main hospital's general license, upon proof that the remote psychiatric inpatient location satisfies the criteria in subsection (2)(d) of this section.

(6) A remote psychiatric inpatient location of a general hospital is subject to state board of health licensing rules for psychiatric hospitals and is not subject to state board of health licensing rules for general hospitals.

(7) Any enforcement action by the department must be taken against the main hospital's general hospital license, regardless of whether the action arises from conduct that occurs at the main hospital location or the remote psychiatric inpatient location.

(8) In the event that the remote psychiatric inpatient location is no longer federally determined as a remote location of a general hospital with provider-based status pursuant to 42 CFR 413.65, the remote psychiatric inpatient location must seek a psychiatric hospital license in order to continue operating.

(9) (a) A health-care facility that delivers health-care services under the name, ownership, and financial and administrative control of a main hospital that does not meet the requirements of subsection (2)(d)(IV) of this section may elect to become a remote psychiatric inpatient location of a general hospital for purposes of this section if the facility:

(I) Was licensed by the department of public health and environment as a psychiatric hospital prior to May 4, 2026;

(II) Was federally determined as a remote location of a general hospital with provider-based status pursuant to 42 CFR 413.65 prior to May 4, 2026;

(III) Meets the criteria described in subsections (2)(d)(II) and (2)(d)(V) of this section; and

(IV) Is certified to accept medicaid and serves medicaid members.

(b) A health-care facility that qualifies as a remote psychiatric inpatient location of a general hospital pursuant to this subjection (9) is subject to the same requirements applied to a remote psychiatric inpatient location pursuant to this section.

Source: L. 09: p. 411, § 1. C.L. § 1053. CSA: C. 78, § 133. CRS 53: § 66-4-1. C.R.S. 1963: § 66-4-1. L. 71: p. 631, § 1. L. 78: Entire section amended, p. 440, § 3, effective May 18. L. 83: Entire section amended, p. 1051, § 1, effective May 25. L. 84: (1) amended, p. 338, § 4, effective April 25. L. 94: (1) amended, p. 2750, § 404, effective July 1. L. 95: Entire section amended, p. 1023, § 2, effective July 1. L. 2002: (1) amended, p. 1329, § 16, effective July 1. L. 2006: (1) amended, p. 1391, § 23, effective August 7. L. 2008: (1) amended, p. 2233, § 2, effective August 5. L. 2011: (1) and (2) amended, (HB 11-1101), ch. 94, p. 277, § 2, effective April 8; (2)(a) amended, (HB 11-1323), ch. 265, p. 1198, § 2, effective June 2. L. 2012: (1) and (2)(a) amended and (4) added, (HB 12-1294), ch. 252, p. 1253, § 3, effective June 4. L. 2019: (1), (2)(a)(I)(B), and (2)(a)(III)(C) amended and (2)(a)(III)(D) added, (HB 19-1010), ch. 324, p. 2998, § 3, effective August 2; (1) amended, (HB 19-1237), ch. 413, p. 3641, § 12, effective July 1, 2022. L. 2020: (2)(a)(III)(A) amended, (SB 20-136), ch. 70, p. 287, § 22, effective September 14. L. 2022: (1) amended, (HB 22-1278), ch. 222, p. 1592, § 228, effective July 1, 2024. L. 2024: (1) amended, (SB 24-121), ch. 439, p. 3066, § 3, effective July 1, 2026. L. 2026: (2)(c), (2)(d), (5), (6), (7), (8), and (9) added, (HB 26-1305), ch. 103, p. 410, § 2, effective May 4.

Editor's note: Amendments to subsection (1) by HB 19-1010 and HB 19-1237 were harmonized, effective July 1, 2022.

Cross references: For the legislative declaration contained in the 1994 act amending subsection (1), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration in the 2012 act amending subsections (1) and (2)(a) and adding subsection (4), see section 1 of chapter 252, Session Laws of Colorado 2012. For the legislative declaration in SB 20-136, see section 1 of chapter 70, Session Laws of Colorado 2020.

ANNOTATION

Law reviews. For comment on Moon v. Mercy Hosp., appearing below, see 35 U. Colo. L. Rev. 612 (1963). For article, "Smith v. O'Halloran: Nursing Home Reform in the Courts", see 13 Colo. Law. 2248 (1984).

Hospital license is prerequisite. A license to operate a hospital is a prerequisite to the functioning of such an establishment. Moon v. Mercy Hosp., 150 Colo. 430, 373 P.2d 944 (1962).

Hospitals and doctors require different licenses. This section and § 12-36-107 are expressions of the legislative will that hospitals and doctors require different licenses. These licenses authorize related but different activities, and the issuance of the one does not permit operation under the other. The general assembly plainly and unequivocally has treated these pursuits as separate and distinct pursuits requiring different licenses. Purcell v. Poor Sisters of St. Francis Seraph, 147 Colo. 478, 364 P.2d 184 (1961); Moon v. Mercy Hosp., 150 Colo. 430, 373 P.2d 944 (1962).

Licensed hospital covered by malpractice limitations section. A hospital which is licensed under this section is clearly embraced within provisions of § 13-80-105 (now § 13-80-102 (1)(c)) prohibiting the bringing of an action to recover from a "licensed health establishment" due to alleged negligence unless such action be instituted within two years after the cause accrued. Adams v. Poudre Valley Hosp. Dist., 173 Colo. 98, 476 P.2d 565 (1970).

Licensing by home-rule city. The provisions of this article do not conflict with any rights of a home-rule city as to the licensing of a chiropractic sanitarium since the general assembly can provide for the licensing of hospitals within the limits of home-rule cities in the interest of general health. Spears Free Clinic & Hosp. for Poor Children v. State Bd. of Health, 122 Colo. 147, 220 P.2d 872 (1950).

Applied in In re Estate of Smith v. O'Halloran, 557 F. Supp. 289 (D. Colo. 1983).