Hospital Discounted Care was created by House Bill (HB) 21-1198 which requires hospitals to screen all uninsured patients and insured patients who request to be screened for Health First Colorado (Colorado's Medicaid Program), the Child Health Plan Plus (CHP+), Medicare, Emergency Medicaid, and financial assistance. Hospitals must give patients the chance to apply for discounted care when they have services at the hospital. Patients who are at or below 250% of the Federal Poverty Guidelines (FPG) are eligible for Hospital Discounted Care. It limits the amounts that low-income patients can be billed for health care services at hospitals and emergency rooms. It also limits amounts billed from providers who work at hospitals and emergency rooms. If the patient qualifies, their billed amounts will be limited to the rates set by the Department of Health Care Policy and Financing (HCPF).
Examples of HDC Approximate Income Limits
| Family Size | Approximate Annual Income | Approximate Monthly Income |
|---|---|---|
| 1 | up to $39,125 | up to $3,260 |
| 2 | up to $52,875 | up to $4,406 |
| 3 | up to $66,625 | up to $5,552 |
| 4 | up to $80,375 | up to $6,697 |
| 5 | up to $94,125 | up to $7,843 |
| 6 | up to $107,875 | up to $8,989 |
| 7 | up to $121,625 | up to $10,135 |
| 8 | up to $135,375 | up to $11,281 |
Billing & Payment Plans
The hospital and health care professionals may bill separately. If billing separately, you may receive a bill from the hospital and another bill from each health care professional. Payment plans for bills from a hospital may not have a monthly payment more than four (4) % of the patient’s gross monthly household income. When Professional Services are being billed separately, each licensed health care professional can set up a payment plan with monthly payments no more than two (2) % of the patient’s gross monthly household income. If everything is on one hospital bill, the payment plan's monthly payment may not be more than six (6) % of the patient’s gross monthly household income. Once 36 months of payments are made, the payment plan is considered fulfilled. Payment plans cannot be longer than 36 months of payments.
Patients' Rights
Per HB 21-1198, the Department developed a Patient's Rights form using feedback from numerous stakeholders. The form is provided below in both English and Spanish.
Effective September 1, 2022, Health Care Facilities must have this Patient's Rights form available to the public and to each patient or each patient's legal guardian. This includes:
- Posting the Spanish and English Patient's Rights form conspicuously on the Health Care Facilities website, including a link to the information on the Health Care Facilities main landing page;
- Make the form available in the patient waiting areas;
- Make the information available to each patient or the patient's legal guardian, verbally, which may include using a professional interpretation service, or in writing in the patient's or legal guardian's preferred language before the patient is discharged from the Health Care Facility; and
- Inform each patient or the patient's legal guardian on the billing statement of the patient's rights. Including the right to apply for discounted care, and provide the website, email address, and telephone number where the information may be obtained in the patient's preferred language.
If any patient or patient's guardian does not receive the Patient's Rights form either in hard copy or electronically, or does not receive it in any of the points listed above, the patient or the patient's guardian may file a complaint with the Department by contacting HCPF_HospDiscountCare@state.co.us.
What Services are Covered?
Emergent and elective services received in a Health Care Facility at all Colorado general acute and critical access hospitals and their off-campus locations, all freestanding emergency departments may be covered. Services provided by Licensed Health Care Professionals in these settings are also covered. Hospital Discounted Care screens patients for eligibility for public health coverage, the Colorado Indigent Care Program (CICP), and discounted health care. Uninsured patients will automatically be screened and can choose not to be screened, but must opt out of the screening. Insured patients may ask to be screened to see if they qualify.
Hospital Discounted Care Rates
Rates are updated annually July 1. Contact us by email at the Hospital Discounted Care inbox HCPF_HospDiscountCare@state.co.us with any questions regarding these rates.
Determination Appeals
If a patient completes the application process and is either determined ineligible for Hospital Discounted Care, or they believe there was an error in their determination which resulted in a higher household income and higher payment plan, they are allowed to appeal to the health care facility. Patients have 30 days from the date the determination was sent to appeal in writing via mail, email, or patient portal message if available. Patients may also appeal if they submitted all documentation required to complete the application and they have not received a determination within 21 days of submitting the documents.
The Health Care Facility must acknowledge the receipt of the appeal within three business days to both the patient and the Department of Health Care Policy and Financing (HCPF). The Health Care Facility has 15 calendar days to review the appeal and make a redetermination of eligibility. The Health Care Facility must inform the patient and HCPF of the redetermination of eligibility within the 15 calendar days.
If the patient is not satisfied with the Health Care Facility’s redetermination, the patient can appeal to HCPF in writing via email to hcpf_hospdiscountcare@state.co.us with a subject line of “Appeal of Discounted Care Redetermination” within 15 calendar days of the redetermination. HCPF will review the appeal within 15 calendar days of receipt of the secondary appeal. If HCPF finds that the Health Care Facility’s redetermination was inaccurate, the Health Care Facility must resend a determination letter to the patient and HCPF stating they are eligible for discounted care for the care received in the Health Care Facility for that specific date or date span.
More Information about Hospital Discounted Care
If you would like to stay up to date with policy and rules, you can sign up to receive the Hospital Discounted Care newsletter.
For additional information about Hospital Discounted Care, please visit the Hospital Discounted Care - Provider Information Page.