4 CCR 735-1
DEPARTMENT OF REGULATORY AGENCIES ATHLETIC TRAINER LICENSURE RULES AND REGULATIONS 4 CCR 735-1 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] _________________________________________________________________________ Basis The authority for the promulgation and adoption of these rules and regulations by the Director of the Division of Professions and Occupations is set forth in section 12-205-116, C.R.S. Purpose These rules are adopted to implement the Director’s authority to license persons as athletic trainers and are further adopted to set forth the requirements for being so licensed.
1.1 Education Requirements
The purpose of this Rule is to provide additional guidance regarding the educational requirements for licensure as set forth in section 12-205-108(1), C.R.S. An applicant who has been certified as an athletic trainer by the Board of Certification, Inc. for the Athletic Trainer (“BOC”) or its predecessor shall be deemed to have met the educational requirements for licensure (all references to BOC in these rules include its predecessor).
1.2 Examination Approved by Director
The purpose of this Rule is to designate a nationally recognized examination approved by the Director pursuant to section 12-205-108(1)(c)(I), C.R.S.
The examination developed and administered by the Board of Certification, Inc., for the Athletic Trainer (“BOC”) is approved by the Director. An applicant must achieve at least the passing score as determined by BOC in order to be eligible for licensure.
1.3 Licensure by Endorsement
The purpose of this Rule is to define substantially equivalent experience and credentials requirements for licensure by endorsement for applicants with an active license in another state set forth in section 12-20- 202(3), C.R.S.
A. An applicant for licensure by endorsement who meets the criteria set forth in section 12-205- 208(1)(a), (b) and (c), C.R.S., shall be deemed to hold “substantially equivalent experience and credentials” as defined in section 12-20-202(3), C.R.S.
B. An applicant for licensure by endorsement who has been certified as an athletic trainer by the BOC or its predecessor shall be deemed to hold “substantially equivalent experience and credentials” as defined in section 12-20-202(3), C.R.S.
1.4 Reinstatement of Expired License
The purpose of this Rule is to establish the qualifications and procedures for reinstatement of an expired license pursuant to sections 12-205-109(2), 12-20-202, and 12-20-105, C.R.S.
A. An applicant seeking reinstatement of an expired license shall complete a reinstatement application and pay a reinstatement fee.
B. If the license has been expired for more than two (2) years an applicant must demonstrate “competency to practice” under section 12-20-202(2)(c)(II), C.R.S., as follows:
C. If the license has been expired for five (5) years or more an applicant is only eligible to complete
1.5 Supervision of Student Athletic Trainers
The purpose of this Rule is to outline the conditions under which a student athletic trainer may practice in Colorado under section 12-205-110(1)(a), C.R.S.
A. For the purposes of section 12-205-110(1)(a), C.R.S., “immediate supervision” of a student athletic trainer by an athletic trainer licensed in Colorado means the supervising, licensed athletic trainer (a) is present on the premises where the services are being performed; and (b) is available for immediate consultation and to assist the person being supervised in the services being performed.
B. For purposes of this Rule, “premises” means within the same facility or area and within close enough proximity to respond in a timely manner to an emergency or the need for assistance.
C. Faculty members teaching nonclinical aspects of athletic training are not required to be licensed athletic trainers.
1.6 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 Procedure 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 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 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 Procedure Act at § 24-4-106, C.R.S.
1.7 Reporting Criminal Convictions, Judgments, and Administrative Proceedings
The purpose of this Rule is to establish reporting procedures for violations of section 12-205-111, C.R.S., to the Director.
A licensee shall inform the Director, in a manner set forth by the Director, within ninety (90) days of any of the following events:
A. The conviction of the licensee of a felony under the laws of any state or of the United States, or a crime related to the practice of athletic training. A guilty verdict, a guilty plea, or a nolo contendere plea accepted by the court is considered a conviction for the purposes of this Rule;
B. A disciplinary action imposed upon the licensee by another jurisdiction that registers or licenses athletic trainers, which would be a violation of section 12-205-111(2)(e) or (h), C.R.S., including, but not limited to, a citation, sanction, probation, civil penalty, or a denial, suspension, revocation, or modification of a license or registration whether it is imposed by consent decree, order, or other decision, for any cause other than failure to pay a license or registration fee by the due date or failure to meet continuing professional education requirements;
C. Revocation or suspension by another state board, municipality, federal or state agency of any health services related license or registration, other than a license or registration for athletic trainers as described in section 12-205-111, C.R.S.;
D. Any judgment, award or settlement of a civil action or arbitration in which there was a final judgment or settlement against the licensee for malpractice of athletic training.
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 with the licensee’s records.
1.8 Exceptions and Director’s Review of Initial Decisions [Repealed].
1.9 Regarding The Continuing Duty To Report Information To The Director’s Office The purpose of this Rule is to set forth the requirement of licensees to notify the Director of a change in submitted information pursuant to section 24-34-107, C.R.S. A licensee shall provide notice to the Director within thirty (30) days of any change in address of record in a manner established by the Director.
1.10 Duty to Self-Report Certain Medical Conditions
The purpose of this Rule is to provide additional guidance regarding the duty to report certain medical conditions and eligibility for entering into a confidential agreement with the Director as set forth in section 12- 205-114, C.R.S.
A. No later than thirty (30) days from the date a licensee becomes aware of a physical or mental illness or condition that affects a licensee’s ability to perform athletic training services with reasonable skill and safety, the licensee shall provide the Director, in writing, the following information:
B. The licensee shall notify the Director of any worsening of the illness or condition, or any significant change in the illness or condition that affects the licensee’s ability to practice with reasonable skill and safety, within thirty (30) days of the change of the illness or condition. The licensee 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 12-205-114, 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 licensee has a mental or physical illness or condition that affects the licensee’s ability to practice with reasonable skill and safety, and the licensee has not timely notified the Director of such illness or condition, the licensee may be subject to disciplinary action pursuant to section 12-205-114 and 12-30-108, C.R.S.
Adopted: December 6, 2016 1.11 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, 12-205-116, and 24-34-113(3), C.R.S., in consultation with the Commissioner of Insurance and the State Board of Health under the authority of section 24-34-113(2), C.R.S.
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 as required by section 24-34-113(2), C.R.S. This Rule applies to health care providers as defined in sections 24-34-113(1)(f) and 10-16-102(56), C.R.S.
A. Disclosure requirements. If a consumer has incurred a claim for emergency or nonemergency health care services from an out-of-network provider, the health care provider shall provide the disclosures contained in Appendix. The health care provider shall provide the disclosure contained in Appendix A at all of the following occasions:
B. Noncompliance with this Rule may result in the imposition of any of discipline made available by section 12-205-111, C.R.S.
Rule 1.12 Rules and Regulations Relating to Education, Training, or Service Gained During Military Service The purpose of this Rule is to delineate the requirements for the Director’s acceptance of education, training, or service gained in the military towards the qualifications for licensure, pursuant to sections 12- 20-204, 12-205-116, and 12-20-202(4), C.R.S.
A. Education, training, or service gained in military services outlined in section 12-20-202(4), C.R.S., to be accepted and applied towards licensure or reinstatement of an expired license, must be substantially equivalent, as determined by the Director, to the qualifications otherwise applicable at the time of receipt of application.
B. It is the applicant’s responsibility to provide timely and complete evidence for review and consideration.
C. Satisfactory evidence of such education, training, or service will be assessed on a case-by-case basis.
D. Documentation of military experience may include, but is not limited to, the applicant’s Certificate of Release or Discharge from Active Duty (DD-214), Verification of Military Experience and Training (DD-2586), military transcript, training records, evaluation reports, or letters from commanding officers describing the applicant’s practice.
1.13 REQUIRED DISCLOSURE TO PATIENTS – CONVICTION OF OR DISCIPLINE BASED ON
A. On or after March 1, 2021, a provider, as defined in Rule 1.1 (E), 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 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.
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 required such as in an inpatient facility, 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 is not required to provide the written disclosure before providing professional services to the patient in the following instances 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 Surprise Billing – Know Your Rights Beginning January 1, 2020, Colorado state law protects you from “surprise billing,” also known as balance billing.
What is surprise/balance billing, and when does it happen? You are responsible for the cost-sharing amounts required by your health plan, including copayments, deductibles, and/or coinsurance. If you are seen by a provider or use services in a facility or agency that are not in your health plan’s network, you may have to pay additional costs associated with that care. These providers or services at facilities or agencies are sometimes referred to as “out-of-network.” Out-of-network facilities or agencies often bill you the difference between what your insurer decides is the eligible charge and what the out-of-network provider bills as the total charge. This is called “surprise” or “balance” billing.
When you CANNOT be balance-billed:
Emergency Services Not every service provided in an emergency department is an emergency service. If you are receiving emergency services, in most circumstances, the most you can be billed for is your plan’s in-network cost- sharing amounts. You cannot be balance-billed for any other amount. This includes both the emergency facility and any providers that see you for emergency care. Nonemergency Services at an In-Network or Out-of-Network Health Care Provider The health care provider must tell you if you are at an out-of-network location or at an in-network location that is using out-of-network providers. They must also tell you what types of services may be provided by any out-of-network provider.
You have the right to request that in-network providers perform all covered medical services. However, you may have to receive medical services from an out-of-network provider if an in-network provider is not available. In this case, the most you can be billed for covered services is your in-network cost-sharing amount (copayments, deductibles, and/or coinsurance). These providers cannot balance bill you. Additional Protections • Your insurer will pay out-of-network providers and facilities directly. Again, you are only responsible for paying your in-network cost-sharing for covered services. • Your insurer must count any amount you pay for emergency services or certain out-of-network services (described above) toward your in-network deductible and out-of-pocket limit. • Your provider or facility must refund any amount you overpay within sixty days of being notified. • A provider, hospital, or outpatient surgical facility cannot ask you to limit or give up these rights. If you receive services from an out-of-network provider or facility or agency OTHER situation, you may still be balance billed, or you may be responsible for the entire bill. If you intentionally receive non-emergency services from an out-of-network provider or facility, you may also be balance billed.
If you want to file a complaint against your health care provider, you can submit an online complaint by visiting this website: https://www.colorado.gov/pacific/dora/DPO_File_Complaint. 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 section 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 section 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 section 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:
_______________________________________________________________ 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 emer. rule eff. 09/17/2009.
Entire rule eff. 11/30/2009.
Rule 8 repealed eff. 10/30/2011.
Rule 10 eff. 01/30/2017.
Entire rule eff. 10/30/2019.
Rule 1.11, Appendix A emer. rules eff. 01/01/2020; expired 04/29/2020. Rule 1.11, Appendix A eff. 04/30/2020.
Rule 1.12 eff. 07/30/2020.
Rules 1.3, 1.13, Appendix B eff. 12/15/2020.
Rules 1.13 E-F eff. 05/30/2021.
Annotations Rule 1.13 E.4 (adopted 10/21/2020) was not extended by Senate Bill 21-152 and therefore expired 05/15/2021.