4 CCR 741-1
DEPARTMENT OF REGULATORY AGENCIES RESPIRATORY THERAPY RULES AND REGULATIONS 4 CCR 741-1 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] _________________________________________________________________________
1.1 Authority
These regulations are adopted pursuant to the authority in sections 12-20-204(1) and 12-300-115, C.R.S., and is intended to be consistent with the requirements of the State Administrative Procedures Act, section 24-4-101 et seq. (the “APA”), C.R.S., and the Respiratory Therapy Practice Act, sections 12-300- 101 et seq. (the “Act”), C.R.S.
1.2 Scope and Purpose
These regulations shall govern the process to become a respiratory therapist and the practice of respiratory therapy in Colorado.
1.3 Oxygen Deliveries
The purpose of this Rule is to define the respiratory therapy services that can be rendered by an unlicensed person delivering oxygen supplies as exempted from the practice of respiratory therapy in section 12-300-112(1)(e), C.R.S.
A. An unlicensed delivery person can deliver, setup, inspect and maintain an oxygen apparatus in a patient's home. An unlicensed delivery person may also instruct the patient about the apparatus' operation.
B. An unlicensed delivery person may not perform pulse oximetry testing, interpret or report physician orders, titrate the oxygen level, discuss disease status with the patient, or engage in any other task or duty that constitutes the practice of respiratory therapy as defined in section 12- 300-104(3), C.R.S.
C. This Rule does not pertain to other licensed health-care professionals practicing within the permitted scope of their profession.
1.4 Declaratory Orders
The purpose of this Rule is to establish procedures for the handling of requests for declaratory orders filed pursuant to the Colorado Administrative Procedures Act at section 24-4-105(11), C.R.S.
A. Any person or entity may petition the Director for a declaratory order to terminate controversies or to remove uncertainties as to the applicability of any statutory provision or of any rule or order of the Director.
B. The Director will determine, at her discretion and without notice to petitioner, whether to rule upon any such petition. If the Director determines that she will not rule upon such a petition, the Director shall promptly notify the petitioner of her action and state the reasons for such decision.
C. In determining whether to rule upon a petition filed pursuant to this Rule, the Director will consider the following matters, among others:
D. Any petition filed pursuant to this Rule shall set forth the following:
E. If the Director determines that she will rule on the petition, the following procedures shall apply:
F. The parties to any proceeding pursuant to this Rule shall be the Director and the petitioner. Any other person may seek leave of the Director to intervene in such a proceeding, and leave to intervene will be granted at the sole discretion of the Director. A petition to intervene shall set forth the same matters as are required by Section (D) of this Rule. Any reference to a “petitioner” in this Rule also refers to any person who has been granted leave to intervene by the Director.
G. Any declaratory order or other order disposing of a petition pursuant to this Rule shall constitute agency action subject to judicial review pursuant to the Colorado Administrative Procedures Act at section 24-4-106, C.R.S.
1.5 Requirement for Reinstatement
The purpose of this Rule is to state the requirements for reinstatement of a license that expired under sections 12-300-108 and 12-20-202, C.R.S.
A. An applicant seeking reinstatement of an expired license shall complete the reinstatement application and pay the reinstatement fee.
B. If the license has been expired for more than two years from the date of receipt of the reinstatement application, but less than five years the applicant will have to establish “competency to practice” under section 12-20-202(2)(c)(II), C.R.S., as follows by submitting:
C. An applicant seeking to reinstate a license that has been expired for more than five years will need to demonstrate “competency to practice” as required in section 12-20-202(2)(c)(II), C.R.S. by:
1.6 Reporting Convictions and Other Adverse Actions
The purpose of the Rule is to clarify the procedures for reporting convictions, and other adverse actions to include judgments and administrative proceedings pursuant to section 12-300-109, C.R.S. A licensee shall inform the Director within thirty days of any of the following events:
A. The licensee has been convicted of or has entered and had accepted by a court a plea of guilty or nolo contendere to a felony under the laws of any state or of the United States which would be a violation of section 12-300-109(2)(b), C.R.S.
B. A disciplinary action imposed upon the licensee by another jurisdiction that licenses respiratory therapists which would be a violation of section 12-300-109(2)(d), C.R.S.
C. Revocation or suspension by another state board, municipality, federal or state agency of any health service related license, other than an expired license for respiratory therapy as described in section 12-300-109(2)(p), C.R.S.
D. Any judgment, award or settlement or a civil action or arbitration in which there was a final judgment or settlement against the licensee for malpractice of respiratory therapy.
E. The notice to the Director shall include the following information:
F. The licensee notifying the Director may submit a written statement with the notice to be included in the licensee’s records.
1.7 Duty to Report Information to the Director’s Office
The purpose of this Rule is to clarify the requirement of licensees to notify the Director of a change in submitted information pursuant to section 24-34-107, C.R.S.
A. The licensee shall inform the Office of Respiratory Therapy Licensure in clear, explicit and unambiguous written statement of any name, address, telephone or email change within 30 days of the change. The Office of Respiratory Therapy Licensure will not change licensees’ information without explicit written notification from the licensee. Notification by any manner approved by the Office of Respiratory Therapy Licensure is acceptable.
B. The Office of Respiratory Therapy Licensure requires one of the following forms of documentation to change a licensee’s name or correct a social security number or individual taxpayer identification number:
1.8 Licensure Requirements: Credit for Military Experience
The purpose of this Rule is to outline the conditions and procedures governing the evaluation of an applicant’s military training and experience under section 12-20-202(4), C.R.S.
A. An applicant for licensure as a respiratory therapist may submit information about the applicant’s education, training, or experience acquired during military service. It is the applicant’s responsibility to provide timely and complete information for the Director’s review.
B. In order to meet the requirements for licensure, such education, training, or experience must be substantially equivalent to the required qualifications that are otherwise applicable at the time the application is received by the Director.
C. The Director will determine, on a case by case basis, whether the applicant’s military education, training, or experience meet the requirements for certification.
1.9 Duty to Self-Report Certain Medical Conditions
The purpose of this Rule is to specify the notification requirements regarding a physical or mental illness or condition that affects a license holder’s ability to practice respiratory therapy or practice as a respiratory therapist with reasonable skill and safety to patients, pursuant to section 12-300-111, C.R.S.
A. No later than thirty days from the date a physical or mental illness or condition impacts a licensed respiratory therapist’s ability to perform respiratory therapy services with reasonable skill and safety, the licensed respiratory therapist shall provide the Director, in writing, the following information:
B. The licensed respiratory therapist shall notify the Director of any worsening of the illness or condition, or any significant change in the illness or condition that affects the licensed respiratory therapist’s ability to practice with reasonable skill and safety, within thirty days of the change of the illness or condition. The respiratory therapist shall provide to the Director, in writing, the following information:
C. Compliance with this Rule is a prerequisite for eligibility to enter into a Confidential Agreement with the Director pursuant to section 12-300-111, C.R.S. However, mere compliance with this Rule does not require the Director to enter into a Confidential Agreement. Rather, the Director will evaluate all facts and circumstances to determine whether a Confidential Agreement is appropriate.
D. If the Director discovers that a licensed respiratory therapist has a mental or physical illness or condition that affects the licensed respiratory therapist’s ability to practice with reasonable skill and safety, and the licensed respiratory therapist did not timely notify the Director of such illness or condition, the licensed respiratory therapist may be subject to disciplinary action pursuant to section 12-300-109(2)(i), C.R.S.
1.10 Concerning Health Care Provider Disclosures to Consumers about the Potential Effects of Receiving Emergency or Nonemergency Services from an Out-of-Network Provider This Rule is promulgated and adopted by the Director of the Division of Professions and Occupations (“Director”), pursuant to the rulemaking authority in sections 12-20-204, 12-30-112, and 12-300-115, C.R.S., in consultation with the Commissioner of Insurance and the State Board of Health. The purpose of this Rule is to establish requirements for health care providers to provide disclosures to consumers about the potential effects of receiving emergency or non-emergency services from an out-of- network provider.
This Rule applies to health care providers as defined in section 10-16-102(56), C.R.S.
A. Definitions, for purposes of this Rule, are as follows:
B. Disclosure requirements.
C. Noncompliance with this Rule may result in the imposition of any of discipline made available by section 12-300-109(2)(g), C.R.S.
1.11 REQUIRED DISCLOSURE TO PATIENTS – CONVICTION OF OR DISCIPLINE BASED ON
A. On or after March 1, 2021, a provider, shall disclose to a patient, as defined in section 12-30- 115(1)(a), C.R.S., instances of sexual misconduct , including a conviction or guilty plea as set forth in section 12-30-115 (2)(a) C.R.S., or final agency action resulting in probation or limitation of the provider’s ability to practice as set forth is section 12-30-115(2)(b), C.R.S.
B. Form of Disclosure: The written disclosure shall include all information specified in section 12-30- 115(3), C.R.S., and consistent with the sample model disclosure form as set forth in Appendix B to these rules. The patient must, through his or her signature on the disclosure form, acknowledge the receipt of the disclosure and agree to treatment with the provider.
C. Timing of Disclosure: This disclosure shall be provided to a patient the same day the patient schedules a professional services appointment with the provider. If an appointment is scheduled the same day that services will be provided or if an appointment is not necessary, the disclosure must be provided in advance of the treatment.
D. As set forth in section 12-30-115(3)(e), C.R.S., the requirement to disclose the conviction, guilty plea, or agency action ends when the provider has satisfied the requirements of the probation or other limitation and is no longer on probation or otherwise subject to a limitation on the ability to practice the provider’s profession.
E. A provider need not make the disclosure required by this section before providing professional services to the patient if any of the following applies as set forth in section 12-30-115(4), C.R.S.:
F. The provider who does not have a direct treatment relationship or have direct contact with the patient is not required to make the disclosure required by this section. APPENDIX A Your Rights and Protections Against Surprise Medical Bills When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You’re protected from balance billing for:
Emergency services If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. If you believe you’ve been wrongly billed by a healthcare provider, please contact the Colorado Office of Respiratory Therapy Licensure at 303-894-7800 or dora_respiratoryboard@state.co.us. Visit the CMS No Surprises Act website (https://www.cms.gov/nosurprises/consumers) for more information about your rights under federal law.
Review section 12-30-112, C.R.S., for more information about your rights under Colorado state law. Certain services at an in-network hospital or ambulatory surgical center When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections. You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network. When balance billing isn’t allowed, you also have these protections: • You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly. • Generally, your health plan must:
If you believe you’ve been wrongly billed by a healthcare provider, please contact the Colorado Office of Respiratory Therapy Licensure at 303-894-7800 or dora_respiratoryboard@state.co.us. The federal phone number for information and complaints is: 1-800-985-3059. Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law. Visit https://dpo.colorado.gov/RespiratoryTherapy for more information about your rights under Colorado state law, pursuant to section 12-30-112, C.R.S.
APPENDIX B MODEL SEXUAL MISCONDUCT DISCLOSURE STATEMENT DISCLAIMER: This Model Sexual Misconduct Disclosure Statement is to be used as a guide only and is aimed only to assist the practitioner in complying with § 12-30-115, C.R.S., and the rules promulgated pursuant to this statute by the Director. As a licensed, registered, and/or certified health care provider in the State of Colorado, you are responsible for ensuring that you are in compliance with state statutes and rules. While the information below must be included in your Sexual Misconduct Disclosure Statement pursuant to § 12-30-115, C.R.S., you are welcome to include additional information that specifically applies to your situation and practice.
A. Provider information, including, at a minimum: name, business address, and business telephone number.
B. A listing of any final convictions of or a guilty plea to a sex offense, as defined in § 16-11.7- 102(3), C.R.S.
C. For each such conviction or guilty plea, the provider shall provide, at a minimum:
D. A listing of any final agency action by a professional regulatory board or agency that results in probationary status or other limitation on the provider’s ability to practice if the final agency action is based in whole or in part on:
E. For each such final agency action by a professional regulatory board or agency the provider shall provide, at a minimum:
Sample Signature Block I have received and read the sexual misconduct disclosure by [Provider Name] and I agree to treatment by [Provider Name].
_______________________________________________________________ Print Client Name _______________________________________________________________ Client or Responsible Party’s Signature Date If signed by Responsible Party (parent, legal guardian, or custodian), print Responsible Party’s name and relationship to client:
_______________________________________________________________ Print Responsible Party Name Print Relationship to Client _______________________________________________________________ Provider Signature Date _________________________________________________________________________ Editor’s Notes History Entire rule eff. 05/01/2010.
Basis, Rules 2.A., 5.A.1., 6, 7, eff. 01/30/2017.
Rule 1.8, Appendix A emer. rules eff. 01/01/2020; expired 04/29/2020. Rule 1.8, Appendix A eff. 04/30/2020.
Rule 1.9 emer. rule eff. 05/01/2020; expired 08/29/2020. Rule 1.10 emer. rule eff. 05/11/2020; expired 09/08/2020. Rule 1.9 emer. rule eff. 08/30/2020.
Rule 1.10 emer. rule eff. 09/09/2020.
Rules 1.1-1.11, Appendices A, B eff. 12/15/2020.
Rules 1.9, 1.10 emer. rules eff. 12/28/2020.
Rule 1.11 emer. rule eff. 01/11/2021.
Rules 1.9, 1.10 emer. rules eff. 04/27/2021.
Rule 1.11 emer. rule eff. 05/11/2021.
Rules 1.11 E-F eff. 05/30/2021.
Rules 1.9, 1.10 emer. rules eff. 07/12/2021.
Rules 1.9, 1.10 emer. rules eff. 11/02/2021.
Rule 1.7 B eff. 11/14/2021.
Rules 1.9, 1.10 emer. rules eff. 03/02/2022.
Rules 1.9, 1.10 emer. rules eff. 06/28/2022.
Rules 1.12, 1.13 emer. rules eff. 08/15/2022.
Rules 1.14, 1.15 emer. rules eff. 10/26/2022.
Rules 1.14, 1.15 emer. rules eff. 11/11/2022.
Rules 1.10, 1.12, 1.13, Appendix A eff. 11/30/2022.
Rules 1.14, 1.15 emer. rules eff. 01/09/2023; expired 05/09/2023. Rules 1.12, 1.13 repealed eff. 12/30/2023.
Annotations Rule 1.11 E.4 (adopted 10/21/2020) was not extended by Senate Bill 21-152 and therefore expired 05/15/2021.
Rules 1.13 B. and 1.13 C. (adopted 10/10/2022) were not extended by Senate Bill 23-102 and therefore expired 05/15/2023.