Days before a hearing on a bill to ban hospital facility fees, supporters of the legislation are backing off a blanket prohibition on those fees.

A lobbyist working on the bill announced in an email to reporters Monday that the measure will be substantially rewritten to remove the outright ban and instead focus the bill on a study of facility fees. That’s often a sign a bill is in trouble – a study is a way to keep the measure going.

In addition, it’s almost unheard of for a lobbyist to email these kinds of changes to multiple reporters, although it’s common knowledge that legislation and amendments are frequently crafted by lobbyists, not lawmakers.

“What is clear,” lobbyist Kachina Weaver wrote, “is there is much more we need to understand about facility fees and their impact on patients, providers, and hospitals. Our first priority is always to ensure that Colorado families can afford to access the critical health care they need.”

Hospital facility fees are charged largely by outpatient clinics, and the bill targets those clinics that are run by hospitals. Those fees often cover everything but the doctor: costs for nurses, x-ray technicians, front desk and security personnel and other service workers.

The fee charged is usually dependent on the complexity of service provided. A walk-in for a minor injury would be far less than for, say, cancer treatment, which is also often done on an outpatient basis. 

Some health insurance companies cover those costs, but others cover only some or even none of it, depending on the contract between the insurer and the health care provider. That puts the charges, which can range from hundreds to thousands of dollars, on the patients. Those charges aren’t disclosed upfront when someone goes into an outpatient clinic and can show up months later. 

Hospitals, however, warn that eliminating the fees would increase wait times and drive doctors out of Colorado when they can’t count on the clinics being properly staffed. In rural communities, it could mean the death knell for hospitals, the Colorado Hospital Association warned, where 80% of their business lies in providing outpatient services.

The hospitals also claim the people backing the bill, which includes the Colorado Consumer Health Initiative and Centennial State Prosperity, don’t understand how the billing system works.

The changes Weaver alluded to include taking out the blanket ban on the fees, and instead add a study that will gather data on those fees, along with putting limits on facility fees for telehealth, primary care and preventative services, the latter they said is already supposed to be no-cost under the Affordable Care Act. It would also exempt the state’s critical access hospitals, all located in rural communities, and “sole community hospitals,” which as defined by federal law are either rural or at least 15 miles from another hospital, with a variety of other conditions. The definition excludes for-profit hospitals. 

The bill would retain its language on transparency, which would require prior notification to consumers on facility fees. 

In a statement Tuesday, the Colorado Hospital Association said they’d heard the bill was being adjusted due to concerns about its consequences. “These are potential amendments, so we still have to react to the bill that is before us. But even if scaled back per the proponent’s message, this will still harm access to care – and especially essential primary and preventive care that is helping Coloradans stay healthier and OUT of the hospital. It will also have a detrimental impact on access to specialty care through telehealth, which many Coloradans – especially in rural parts of the state – have come to depend on.” 

They pledged to continue to work with their member hospitals, bill sponsors Reps. Emily Sirota of Denver and Andrew Boesenecker of Fort Collins and its backers on a path forward.

The hearing on HB 1215 is scheduled for Friday in the House Health & Insurance Committee upon adjournment of House business.