Last year Colorado, like many other states, passed new legislation that affects patient requests for medical records and the fees that may be charged for copies of the medical records. House Bill 14-1186, codified at C.R.S. § 25-1-801, with related regulations at 6 CCR 1011-1, Ch. 1, Part 5. The law changes the fees that may be charged for providing copies of records and adds provisions relating to the delivery of records in electronic format. These provisions apply to medical records in the custody of a broad range of health care facilities (see C.R.S. § 25-1.5-103(1)) , including hospitals, nursing homes, assisted living residences, and hospice.
Colorado law requires that health care facilities make medical records available for inspection by a current patient or the patient’s personal representative at reasonable times and upon reasonable notice, except for certain records withheld in accordance with 45 § C.F.R. 164.524(a). A reasonable time for inspection should normally not exceed 24 hours from the date of the request (excluding weekends and holidays) for an inpatient or current resident. The patient or designated representative may not be charged for inspecting the records.
With regard to a discharged patient or resident, a health care facility must make a copy of the record available or make the record available for inspection within a reasonable time from the date of the signed request, normally not to exceed ten days, excluding weekends and holidays. However, if the health care provider or designated representative is not available to acknowledge the request, the facility shall inform the patient of the situation and provide the records as soon as possible. Discharged patients or their representatives cannot be charged for inspecting patient records.
Health care facilities should be aware of certain provisions of Colorado law relating to electronic records and films. Medical records must be delivered in electronic format if the records are requested in electronic format, they are stored in electronic format, and are readily producible in electronic format. Finally, a health care facility must release the original film if a licensed health care professional determines that a copy is not sufficient for diagnostic or other treatment purposes.
The amount that may be charged for medical records varies, depending upon the requesting party. When a patient or a personal representative requests a copy of medical records, the fees are set in accordance with HIPAA. Under HIPAA, a covered entity may charge a patient or a personal representative a reasonable, cost-based fee for providing a copy of medical records; this fee may encompass the cost of copying (including the cost of supplies for and labor of copying) and postage. However, health care facilities may charge third parties fees that are established under state law. Thus, the HIPAA fee limitations do not apply when records are released under other HIPAA-compliant situations, such as requests that are based on an individual’s authorization.
Colorado law establishes the following reasonable fees that a health care facility may charge a third party. The fees may not exceed the following:
- For the first ten pages: $18.53
- For the next thirty pages (pages 11 through 40): 85 cents per page
- Each additional page after page 40 : 57 cents per page (all records except those stored on microfilm) or $1.50 per page (records stored on microfilm)
- Actual reproduction costs for each copy of a radiograph
- Certification of medical records, if requested: $10.00 fee
- Actual postage and electronic media costs if applicable
- Applicable taxes
Under certain circumstances, third parties may not be required to pay any fees or a different fee schedule may apply. If a patient record is requested under the Laura Hershey Disability-Benefit Support Act, C.R.S. §§ 24-30-2201 through 2207, the third party may obtain one free copy of the record for the application process or for an appeal or reapplication when required by the disability benefits administrator. Where a statute or rule for a state or local government entity establishes maximum rates, these rates prevail. Finally, the statutory fee schedule does not apply to coroners requesting medical records.
Health care facilities should review their policies on releasing and charging for copies of medical records to ensure that they are in compliance with recent changes in Colorado law.