Colorado § 25-49-102 - Definitions.

§ 25-49-102. Definitions.

As used in this article 49, unless the context otherwise requires:

(1) "Agency" means a government department or agency or a government-created entity.

(2) "CPT code" means the current procedural terminology code, or its successor code, as developed and copyrighted by the American Medical Association or its successor entity.

(3) "Health-care facility" means a facility licensed or certified by the department of public health and environment pursuant to section 25-1.5-103. The term does not include a nursing care facility, assisted living residence, or home care agency.

(4) (a) "Health-care price" means the price, before negotiating any discounts, that a health-care provider or health-care facility will charge a recipient for health-care services that will be rendered. "Health-care price" is the price charged for the standard service for the particular diagnosis and does not include any amount that may be charged for complications or exceptional treatment. The health-care price for a specific health-care service may be determined from any of the following:

(I) The price charged most frequently for the health-care service during the previous twelve months;

(II) The highest charge from the lowest half of all charges for the health-care service during the previous twelve months; or

(III) A range that includes the middle fifty percent of all charges for the health- care service during the previous twelve months.

(b) "Health-care price" does not mean the amount charged if a public or private third party will be paying or reimbursing the health-care provider or health-care facility for any portion of the cost of services rendered.

(5) "Health-care provider" means a person who is licensed, certified, or registered by this state to provide health-care services or a medical group, independent practice association, or professional corporation providing health-care services.

(6) (a) "Health-care services" or "services" means services included in, or incidental to, furnishing to an individual:

(I) Medical, mental, dental, or optometric care or hospitalization; or

(II) Other services for the purpose of preventing, alleviating, curing, or healing a physical illness, an injury, or a mental health disorder.

(b) "Health-care services" includes services rendered through the use of telemedicine.

(7) "Health insurer" means a carrier, as defined in section 10-16-102 (8), disability insurer, group disability insurer, or blanket disability insurer.

(8) (a) "Public or private third party" means a health insurer, self-insured employer, or other third party, including a third-party administrator or intermediary, responsible for paying all or a portion of the charges for health-care services.

(b) "Public or private third party" does not mean:

(I) An employer of the recipient of the health-care services that is not responsible for paying the charges for the health-care services provided to the recipient;

(II) A person paying money from a health savings account, flexible spending account, or similar account; or

(III) A family member, charitable organization, or other person who is not responsible for, but pays charges for, health-care services on behalf of the recipient of the services.

(9) "Punish" means to impose a penalty, surcharge, fee, or other additional cost or measure that has the same effect as a penalty or that discourages the exercise of rights under this article 49.

(10) "Recipient" means an individual who receives health-care services from a health-care provider or health-care facility.

(11) "Self-pay" means payment without the assistance of a public or private third party.

Source: L. 2017: Entire article added, (SB 17-065), ch. 113, p. 403, § 1, effective January 1, 2018. L. 2018: (6)(a)(II) amended, (SB 18-091), ch. 35, p. 388, § 24, effective August 8. L. 2023: (11) added, (SB 23-093), ch. 152, p. 647, § 7, effective May 4.

Cross references: For the legislative declaration in SB 18-091, see section 1 of chapter 35, Session Laws of Colorado 2018.