ACUPUNCTURE LICENSURE RULES AND REGULATIONS

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Code of Colorado Regulations › 700 Department of Regulatory Agencies › 738 Division of Professions and Occupations - Office of Acupuncture Licensure › 4 CCR 738-1

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DEPARTMENT OF REGULATORY AGENCIES

Office of Acupuncture Licensure

ACUPUNCTURE LICENSURE RULES AND REGULATIONS

4 CCR 738-1

[Editor’s Notes follow the text of the rules at the end of this CCR Document.]

_________________________________________________________________________

1.1

Requirement for Licensure

The purpose of this Rule is to establish the qualifications for an acupuncturist license as required in

sections 12-200-106(3) and 12-20-202(4), C.R.S.

In order to qualify for licensure - an applicant must demonstrate the following:

Graduation from a diploma program in acupuncture and Oriental medicine accredited by

the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) or

successor organization and successful completion of the NCCAOM Board examinations;

the California Licensure Examination or a substantially equivalent examination as

determined by the Director; or

Graduation from a non-accredited diploma program in acupuncture and Oriental medicine

that is substantially equivalent to a program accredited by the ACAOM as determined by

the Director and a certification issued by NCCAOM or a successor organization.

Education, training, or service gained in military services outlined in section 12-20-202(4), C.R.S.,

to be accepted and applied towards receiving a license, must be substantially equivalent, as

determined by the Director, to the qualifications otherwise applicable at the time of receipt of

application. It is the applicant’s responsibility to provide timely and complete evidence for review

and consideration. Satisfactory evidence of such education, training, or service will be assessed

on a case by case basis.

1.2

Licensure by Endorsement

The purpose of this Rule is to establish the experience or credentials deemed substantially equivalent for

an acupuncturist license by endorsement pursuant to section 12-20-202(3), C.R.S.

ibility to provide timely and complete evidence for review

and consideration. Satisfactory evidence of such education, training, or service will be assessed

on a case by case basis.

1.2

Licensure by Endorsement

The purpose of this Rule is to establish the experience or credentials deemed substantially equivalent for

an acupuncturist license by endorsement pursuant to section 12-20-202(3), C.R.S.

For an applicant to establish “substantially equivalent experience or credentials” under section

12-20-202(3), C.R.S., the applicant must demonstrate:

Graduation from a diploma program in acupuncture and Oriental medicine accredited by

the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) or a

successor organization; and successful completion of the NCCAOM examination, the

California Licensing Examination; or a substantially equivalent examination as

determined by the Director;

Graduation from a non-accredited diploma program in acupuncture and Oriental medicine

that is substantially equivalent to a program accredited by the ACAOM as determined by

the Director and a certification by NCCAOM or a successor organization; or

Code of Colorado Regulations

Secretary of State

State of Colorado

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Having held for at least one year a current and valid acupuncturist license in a jurisdiction

with a scope of practice that is substantially similar to the scope of practice for

acupuncturists as defined under Article 200, of Title 12, C.R.S.

Verification of licensure in another state, through the federal government, or in a military

occupational specialty, as defined in section 24-4-201, C.R.S., shall be provided in a manner

prescribed by the Director.

1.3

Requirements for Reinstatement

The purpose of this Rule is to state the requirements for reinstatement of a license that has expired,

pursuant to section 12-200-106(4), C.R.S.

Verification of licensure in another state, through the federal government, or in a military

occupational specialty, as defined in section 24-4-201, C.R.S., shall be provided in a manner

prescribed by the Director.

1.3

Requirements for Reinstatement

The purpose of this Rule is to state the requirements for reinstatement of a license that has expired,

pursuant to section 12-200-106(4), C.R.S.

An applicant seeking reinstatement of an expired license shall complete a reinstatement

application, pay a reinstatement fee, and attest to malpractice insurance in the amount required

by statute.

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 an applicant shall establish competency to

practice under sections 12-20-202(2)(c)(II), C.R.S., and 12-20-105, C.R.S., by demonstrating one

of the following:

Licensure in good standing from another state along with proof of active practice in that

state for two years of the previous five years from the date of application for

reinstatement.

Completion of thirty hours of continuing education courses related to the practice of

acupuncture during the two years immediately preceding the application for

reinstatement. The continuing education must meet the approval of and shall be attested

to in a manner prescribed by the Director.

Active certification by NCCAOM or a successor organization.

Competency to practice by any other means approved by the Director.

An applicant seeking to reinstate a license that has been expired for more than five years shall

establish competency to practice as required in section 12-20-202(2)(c)(II), C.R.S. by

demonstrating one of the following:

Licensure in good standing from another state along with proof of active practice for two

years of the previous five years from the date of application for reinstatement.

Completion of supervised practice for a period no less than six months subject to the

terms established by the Director.

o practice as required in section 12-20-202(2)(c)(II), C.R.S. by

demonstrating one of the following:

Licensure in good standing from another state along with proof of active practice for two

years of the previous five years from the date of application for reinstatement.

Completion of supervised practice for a period no less than six months subject to the

terms established by the Director.

Competency to practice by any other means approved by the Director.

1.4

Unlicensed Persons in Acupuncture Training Programs

The purpose of this Rule is to identify the circumstances and conditions under which a person in training

may practice acupuncture without a valid and current license on file with the Division of Professions and

Occupations pursuant to section 12-200-108(3), C.R.S.

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A person in training may practice acupuncture without a valid and current license issued by the

Division of Professions and Occupations if such practice takes place in the course of a bona fide

training program. A bona fide training program is a training or apprenticeship program with an

accredited school of acupuncture.

A person in training shall be supervised by an acupuncturist licensed in Colorado who holds an

active and unrestricted license to practice acupuncture in Colorado.

Section 12-200-108(3), C.R.S., requires a supervising acupuncturist to provide direct, on-site

supervision of persons in training. Direct supervision shall mean supervision that is on the

premises and in the same building where any such persons in training are practicing.

A person in training may engage in the full scope of the practice of acupuncture as defined in

section 12-200-103(5)(a), C.R.S.

on 12-200-108(3), C.R.S., requires a supervising acupuncturist to provide direct, on-site

supervision of persons in training. Direct supervision shall mean supervision that is on the

premises and in the same building where any such persons in training are practicing.

A person in training may engage in the full scope of the practice of acupuncture as defined in

section 12-200-103(5)(a), C.R.S.

The supervising acupuncturist is responsible for maintaining documentation detailing the

beginning and ending dates of the bona fide training program and for ensuring that the names

and current addresses of all supervised persons in training are maintained by the supervising

acupuncturist and are readily available for inspection at the request of the Director or designee.

1.5

Use of Title and Restrictions

The purpose of this Rule is to clarify the use of title “licensed acupuncturist” and “diplomat of

acupuncture”, and use of the designations “L.Ac.” and “Dipl. Ac.” under section 12-200-108(2)(b)(II),

C.R.S.

Obtaining an acupuncturist license does not automatically entitle or confer upon the licensee the

right to use the title “Dr.” or “Doctor.”

A licensed acupuncturist can use the title “Doctor” or Dr. only when such licensee has, in fact,

been awarded a doctorate degree from an acupuncture or oriental medicine

academic/educational institution and satisfies the requirements of section 6-1-707, C.R.S.

In such instances where a licensee qualifies to use the title “Doctor” or “Dr.”, an acupuncturist can

use the title “Doctor” or “Dr.” only when accompanied by the words “Doctor of Acupuncture” or

letters “D.Ac.”, “Oriental Medicine Doctor” or “OMD”, “Doctor of Acupuncture and Oriental

Medicine” or “D.Ac.OM”, “Doctor of Traditional Chinese Medicine” or “DTCM”, “Doctor of

Acupuncture and Oriental Medicine” or “DAOM”, or any other doctoral degree recognized and

approved by the Director

puncturist can

use the title “Doctor” or “Dr.” only when accompanied by the words “Doctor of Acupuncture” or

letters “D.Ac.”, “Oriental Medicine Doctor” or “OMD”, “Doctor of Acupuncture and Oriental

Medicine” or “D.Ac.OM”, “Doctor of Traditional Chinese Medicine” or “DTCM”, “Doctor of

Acupuncture and Oriental Medicine” or “DAOM”, or any other doctoral degree recognized and

approved by the Director.

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 Procedures Act at section 24-4-105(11), C.R.S.

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.

The Director will determine, at her discretion and without notice to petitioner, whether to rule upon

such petition. If the Director determines that the Director will not rule upon such a petition, the

Director shall promptly notify the petitioner of the action and state the reasons for such decision.

In determining whether to rule upon a petition filed pursuant to this rule, the Director will consider

the following matters, among others:

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Whether a ruling on the petition will terminate a controversy or remove uncertainties as to

the applicability to petitioner of any statutory provisions or rule or order of the Director.

Whether the petition involves any subject, question or issue that is the subject of a formal

or informal matter or investigation currently pending before the Director or a court

involving one or more petitioners.

Whether the petition involves any subject, question or issue that is the subject of a formal

or informal matter or investigation currently pending before the Director or a court but not

involving any petitioner.

any subject, question or issue that is the subject of a formal

or informal matter or investigation currently pending before the Director or a court

involving one or more petitioners.

Whether the petition involves any subject, question or issue that is the subject of a formal

or informal matter or investigation currently pending before the Director or a court but not

involving any petitioner.

Whether the petition seeks a ruling on a moot or hypothetical question or will result in an

advisory ruling or opinion.

Whether the petitioner has some other adequate legal remedy, other than an action for

declaratory relief pursuant to Colorado Rules of Civil Procedure 57, which will terminate

the controversy or remove any uncertainty as to the applicability to the petitioner of the

statute, rule, or order in question.

Any petition filed pursuant to this rule shall set forth the following:

The name and address of the petitioner and whether the petitioner is licensed pursuant to

Title 12, Article 200.

The statute, rule, or order to which the petition relates.

A concise statement of all of the facts necessary to show the nature of the controversy or

uncertainty and the manner in which the statute, rule, or order in question applies or

potentially applies to the petitioner.

If the Director decides to rule on the petition, the following procedures shall apply:

The Director may rule upon the petition based solely upon the facts presented in the

petition. In such a case:

Any ruling of the Director will apply only to the extent of the facts presented in the

petition and any amendment to the petition.

The Director may order the petitioner to file a written brief, memorandum, or

statement of position.

The Director may set the petition, upon due notice to petitioner, for a non-

evidentiary hearing.

The Director may dispose of the petition on the sole basis of the matters set forth

in the petition.

The Director may request the petitioner to submit additional facts in writing

petition.

The Director may order the petitioner to file a written brief, memorandum, or

statement of position.

The Director may set the petition, upon due notice to petitioner, for a non-

evidentiary hearing.

The Director may dispose of the petition on the sole basis of the matters set forth

in the petition.

The Director may request the petitioner to submit additional facts in writing. In

such event, such additional facts will be considered as an amendment to the

petition.

The Director may take administrative notice of facts pursuant to the Colorado

Administrative Procedures Act at section 24-4-105(8), C.R.S., and may utilize the

Director’s experience, technical competence, and specialized knowledge in the

disposition of the petition.

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If the Director rules upon the petition without a hearing, the Director shall promptly notify

the petitioner of her decision.

The Director may, at the Director’s discretion, set the petition for hearing, upon due notice

to petitioner, for the purpose of obtaining additional facts or information or to determine

the truth of any facts set forth in the petition or to hear oral argument on the petition. The

hearing notice to the petitioner shall set forth, to the extent known, the factual or other

matters that the Director intends to inquire.

For the purpose of such a hearing, to the extent necessary, the petitioner shall have the

burden of proving all the facts stated in the petition; all of the facts necessary to show the

nature of the controversy or uncertainty; and the manner in which the statute, rule, or

order in question applies or potentially applies to the petitioner and any other facts the

petitioner desires the Director to consider.

The parties to any proceeding pursuant to this rule shall be the Director and the petitioner

ing all the facts stated in the petition; all of the facts necessary to show the

nature of the controversy or uncertainty; and the manner in which the statute, rule, or

order in question applies or potentially applies to the petitioner and any other facts the

petitioner desires the Director to consider.

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.

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.

1.7

Reporting Convictions, Judgments and Administrative Proceedings

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 sections 12-200-105, 12-200-106, and 12-

200-109, C.R.S.

A licensee as defined in section 12-200-103, C.R.S., shall inform the Director, in a manner set forth by the

Director, within thirty days of any of the following events:

The conviction of the licensee of a felony under the laws of any state or of the United States,

which would be a violation of section 12-200-109(1)(n), C.R.S. A guilty verdict, a plea of guilty or

a plea of nolo contendere (no contest) accepted by the court is considered a conviction;

nform the Director, in a manner set forth by the

Director, within thirty days of any of the following events:

The conviction of the licensee of a felony under the laws of any state or of the United States,

which would be a violation of section 12-200-109(1)(n), C.R.S. A guilty verdict, a plea of guilty or

a plea of nolo contendere (no contest) accepted by the court is considered a conviction;

A disciplinary action imposed upon the licensee by another jurisdiction that licenses

acupuncturists, which would be a violation of section 12-200-109, C.R.S., including, but not

limited to, a citation, sanction, probation, civil penalty, or a denial, suspension, revocation, or

modification of a license whether it is imposed by consent decree, order, or other decision, for

any cause other than failure to pay a license fee by the due date or failure to meet continuing

professional education requirements;

Revocation or suspension by another state board, municipality, federal or state agency of any

health services related license, other than a lapsed license for acupuncture as described in

Section 12-200-109, C.R.S.;

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 acupuncture.

The notice to the Director shall include the following information;

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than a lapsed license for acupuncture as described in

Section 12-200-109, C.R.S.;

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 acupuncture.

The notice to the Director shall include the following information;

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If the event is an action by a governmental agency (as described above), the name of the

agency, its jurisdiction, the case name, court docket, proceeding or case number by

which the event is designated, and a copy of the consent decree, order or decision;

If the event is a felony conviction, the court, its jurisdiction, the case name, the case

number, a description of the matter or a copy of the indictment or charges, and any plea

or verdict entered by the court. The licensee shall also provide to the Director a copy of

the imposition of sentence or judgment, whether deferred or immediate, related to the

felony conviction and the completion of all terms of the sentence or judgment with thirty

(30) days of such action;

If the event concerns a civil action or arbitration proceeding, the court or arbiter, the

jurisdiction, the case name, the case number, court docket, a description of the matter or

a copy of the complaint, and a copy of the verdict, the court or arbitration decision, or, if

settled, the settlement agreement and court’s order of dismissal;

The licensee notifying the Director may submit a written statement with the notice to be included

with the licensee records.

1.8

Exceptions and Director’s Review of Initial Decisions (Repealed)

1.9

Duty to Self-Report Certain Medical Conditions (Section 12-200-112, C.R.S.)

No later than thirty days from the date a physical or mental illness or condition that affects a

licensee’s ability to perform acupuncture services with reasonable skill and safety, the licensee

shall provide the Director, in writing, the following information:

and Director’s Review of Initial Decisions (Repealed)

1.9

Duty to Self-Report Certain Medical Conditions (Section 12-200-112, C.R.S.)

No later than thirty days from the date a physical or mental illness or condition that affects a

licensee’s ability to perform acupuncture services with reasonable skill and safety, the licensee

shall provide the Director, in writing, the following information:

The diagnosis and a description of the illness or condition;

The date that the illness or condition was first diagnosed;

The name of the current treatment provider and documentation from the current

treatment provider confirming the diagnosis, date of onset, and treatment plan; and

A description of the acupuncturist’s practice and any modifications, limitations or

restrictions to that practice that have been made as a result of the illness or condition.

The licensee shall notify the Director of any worsening 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 days of the change of the illness or

condition. The acupuncturist shall provide to the Director, in writing, the following information:

The name of the current treatment provider, documentation from the current treatment

provider confirming the change of the illness or condition, the date that the illness or

condition changed, the nature of the change of the illness or condition, and the current

treatment plan; and

A description of the licensee’s practice, and any modifications, limitations, or restrictions

to that practice that have been made as a result of the change of condition.

Compliance with this Rule is a prerequisite for eligibility to enter into a Confidential Agreement

with the Director pursuant to section 12-200-112(1), C.R.S. However, mere compliance with this

rule does not require the Director to enter into a Confidential Agreement

and any modifications, limitations, or restrictions

to that practice that have been made as a result of the change of condition.

Compliance with this Rule is a prerequisite for eligibility to enter into a Confidential Agreement

with the Director pursuant to section 12-200-112(1), 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.

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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 12-200-109(1)(l), C.R.S.

1.10

Injection Therapy

Definitions. For purposes of this Rule only:

The Director recognizes that “Injection therapy” is the stimulation of acupuncture points,

including trigger points(historically known as “AHSHI” points), by the injection of saline,

sterile herbs, vitamins, minerals, homeopathic substances, glucose, lidocaine, procaine,

and sarapin, or other similar substances specifically manufactured for nonintravenous

injection by means of hypodermic needles.

Except as restricted by paragraph (C) of this Rule, an acupuncturist with an active license may

practice injection therapy in the treatment of patients in his or her care,

Requirements to Practice Injection Therapy. The acupuncturist shall:

Possess a Colorado acupuncture license in good standing;

Hold a current Clean Needle Technique Certificate through the NCCAOM (or successor

organization); and

Be current in basic life support (BLS) or cardiopulmonary resuscitation (CPR) approved

by the American Heart Association or American Red Cross;

s or her care,

Requirements to Practice Injection Therapy. The acupuncturist shall:

Possess a Colorado acupuncture license in good standing;

Hold a current Clean Needle Technique Certificate through the NCCAOM (or successor

organization); and

Be current in basic life support (BLS) or cardiopulmonary resuscitation (CPR) approved

by the American Heart Association or American Red Cross;

Complete educational coursework covered in subsection D.

Acupuncturists employing injection therapy shall use only those substances and techniques for

which they have received training. Required Educational Coursework shall include:

Anatomy and Physiology;

Acupuncture physical exam and differential diagnosis;

Acupuncture point location, including underlying anatomy;

Acupuncture needling technique;

General injection safety;

Acupuncture point injection therapy;

Pharmacology; and

Clean Needle Technique.

For the use of injectable substances prepared from sterile herbs, completion of training in

Chinese herbology and injection of Chinese herbal injectables is required.

To demonstrate satisfying the training requirements in Chinese herbology and injection of

Chinese herbal injectables the Director will accept NCCAOM, or a successor

organization’s, certification in Chinese herbology and/or certification in Oriental Medicine.

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herbology and injection of Chinese herbal injectables is required.

To demonstrate satisfying the training requirements in Chinese herbology and injection of

Chinese herbal injectables the Director will accept NCCAOM, or a successor

organization’s, certification in Chinese herbology and/or certification in Oriental Medicine.

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10.

For the use of substances listed in (E)(3)(a)(12-17), instruction on the use of inhaled O2

and IM epinephrine for emergency use is required.

Permissible Substances

An acupuncturist shall comply with all federal and state laws that pertain to obtaining,

possessing and administering any drug;

A substance shall only be approved for use if procured in compliance with all federal and

state laws;

The following drugs are authorized in the modes of administration that are specified

except as limited or restricted by federal or state law:

Permissible substances that an acupuncturist may obtain for injection therapy as

permitted per section 12-200-103(4), C.R.S and as permitted by the Director:

(1)

Dextrose;

(2)

d-glucose;

(3)

Enzymes except urokinase;

(4)

Glucose;

(4)

Homeopathic Substances (to only include those that are within the US

Pharmacopia);

(5)

Hyaluronic Acid;

(6)

Minerals;

(7)

Saline;

(8)

Sarapin;

(9)

Sodium chloride;

(9)

Sterile water;

(10)

Traumeel;

(11)

Vitamins;

(12)

Cyanocobalamin;

(13)

Lidocaine;

(14)

Marcaine (Bupivacaine Hydrochloride) with or without epinephrine;

(15)

Sterile Herbs;

(16)

Procaine; and

zymes except urokinase;

(4)

Glucose;

(4)

Homeopathic Substances (to only include those that are within the US

Pharmacopia);

(5)

Hyaluronic Acid;

(6)

Minerals;

(7)

Saline;

(8)

Sarapin;

(9)

Sodium chloride;

(9)

Sterile water;

(10)

Traumeel;

(11)

Vitamins;

(12)

Cyanocobalamin;

(13)

Lidocaine;

(14)

Marcaine (Bupivacaine Hydrochloride) with or without epinephrine;

(15)

Sterile Herbs;

(16)

Procaine; and

(17)

Vitamin B-12.

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Patient safety.

Acupuncturists shall have an adverse event/emergency plan in place.

An acupuncturist practicing injection therapy of substances listed in (E)(3)(a)(12)-(17)

shall be equipped and trained to treat patients with oxygen and epinephrine. The oxygen

and emergency epinephrine kit shall be on site where injection therapy utilizing

substances with potential allergic side effects are being rendered.

An acupuncturist authorized to practice injection therapy shall not inject any substance

intravenously.

Acupuncturists shall show current medical malpractice coverage for this procedure and maintain

coverage.

It is the acupuncturist’s responsibility to only inject substances that are listed in

subsection E and are explicitly covered by the acupuncturist’s insurance policy obtained

in compliance with section 12-200-106(6), C.R.S.

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 pursuant to sections 12-20-204, 12-30-112, and 12-200-114(1)(a), 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 covered persons who are

utilizing a health benefit plan about the potential of balance billing when receiving post-stabilization

services or covered non-emergency services from an out-of-network provider at an in-network facility

ith 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 covered persons who are

utilizing a health benefit plan about the potential of balance billing when receiving post-stabilization

services or covered non-emergency services from an out-of-network provider at an in-network facility.

This rule applies to health care providers. Balance billing by a health care provider is only permitted when

the criteria established in Colorado law, including but not limited to sections 12-30-112 and 12-30-113,

C.R.S., are met.

Definitions, for purposes of this rule, are as follows:

“Ancillary Services” as defined in section 12-30-112(1)(a), C.R.S.

“Balance Bill” and “Balance Billing” as defined in section 10-16-704(19)(c), C.R.S.

“Covered Non-emergency Services” means services that are not emergency services as

defined in section 10-16-704(19)(e), C.R.S., are services covered by a covered person’s

health benefit plan, and are not ancillary services as defined in section 12-30-112(1)(a),

C.R.S.

“Covered Person” as defined by section 10-16-102(15), C.R.S.

“Health Benefit Plan” as defined by section 10-16-102(32), C.R.S.

“Health Care Provider” means “provider,” as defined in section 10-16-102(56), C.R.S.

“In-Network Facility” means a facility, either within or outside of Colorado, that, under a

contract with a carrier or with its contractor or subcontractor, has agreed to provide

health-care services to covered persons with an expectation of receiving payment, other

than coinsurance, copayments, or deductibles, directly or indirectly, from the carrier.

“Out-of-Network Provider” means a Health Care Provider who is not a “Participating

Provider.”

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ts contractor or subcontractor, has agreed to provide

health-care services to covered persons with an expectation of receiving payment, other

than coinsurance, copayments, or deductibles, directly or indirectly, from the carrier.

“Out-of-Network Provider” means a Health Care Provider who is not a “Participating

Provider.”

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“Participating Provider” as defined in section 10-16-102(46), C.R.S.

10.

“Post-Stabilization Services” means covered services related to an emergency medical

condition, as defined in section 10-16-704(19)(d), C.R.S., that are provided once the

criteria set forth in section 10-16-704(19)(e)(III) are met.

Disclosure requirements.

An Out-of-Network Provider may balance bill a Covered Person for (a) Post-Stabilization

Services in accordance with section 10-16-704, C.R.S., and (b) Covered Non-Emergency

Services provided in an In-Network Facility that are not Ancillary Services, but only if the

Out-of-Network Provider meets the requirements set forth in section 12-30-112(3.5),

C.R.S.

If a Covered Person may incur a claim for Post-Stabilization Services or Covered Non-

Emergency Services from an Out-of-Network Provider, the Out-of-Network Provider shall

complete and provide the notice contained in Appendix A to these rules or a similar

disclosure which complies with the requirements set forth in section 12-30-112(3.5),

C.R.S.

Such notice must be provided in the 15 most common languages in Colorado, which, for

purposes of this regulation, are English, Spanish, Vietnamese, Chinese, Korean,

Russian, Amharic, Arabic, German, French, Nepali, Tagalog, Japanese, Cushite,

Persian.

If applicable and in addition to their responsibilities under this Rule, Health Care Providers shall

also comply with the “No Surprises Act,” 42 U.S.C.A. § 300gg-111, Pub.L 116-260, as amended.

languages in Colorado, which, for

purposes of this regulation, are English, Spanish, Vietnamese, Chinese, Korean,

Russian, Amharic, Arabic, German, French, Nepali, Tagalog, Japanese, Cushite,

Persian.

If applicable and in addition to their responsibilities under this Rule, Health Care Providers shall

also comply with the “No Surprises Act,” 42 U.S.C.A. § 300gg-111, Pub.L 116-260, as amended.

Noncompliance with this Rule may result in the imposition of any of discipline made available by

section 12-200-109(1)(i) and 12-200-110, C.R.S.

1.12

REQUIRED DISCLOSURE TO PATIENTS – CONVICTION OF OR DISCIPLINE BASED ON

SEXUAL MISCONDUCT

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.

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 registrant.

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.

The written disclosure and agreement to treatment must be completed prior to each

treatment appointment with a patient unless the treatment will occur in a series over

multiple appointments or a patient/patient schedules follow-up treatment appointments.

same day that services will be provided or if an appointment is not necessary, the disclosure

must be provided in advance of the treatment.

The written disclosure and agreement to treatment must be completed prior to each

treatment appointment with a patient unless the treatment will occur in a series over

multiple appointments or a patient/patient schedules follow-up treatment appointments.

For treatment series or follow-up treatment appointments, one disclosure prior to the first

appointment is sufficient, unless the information the provider is required to disclose

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pursuant to section 12-30-115, C.R.S., has changed since the most recent disclosure, in

which case an updated disclosure must be provided to a patient and signed before

treatment may continue.

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.

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.:

The patient is unconscious or otherwise unable to comprehend the disclosure and sign

an acknowledgment of receipt of the disclosure pursuant to section 12-30-115(3)(d),

C.R.S., and a guardian of the patient is unavailable to comprehend the disclosure and

sign the acknowledgment;

The visit occurs in an emergency room or freestanding emergency department or the visit

is unscheduled, including consultations in inpatient facilities; or

The provider who will be treating the patient during the visit is not known to the patient

until immediately prior to the start of the visit.

ardian of the patient is unavailable to comprehend the disclosure and

sign the acknowledgment;

The visit occurs in an emergency room or freestanding emergency department or the visit

is unscheduled, including consultations in inpatient facilities; or

The provider who will be treating the patient during the visit is not known to the patient

until immediately prior to the start of the visit.

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.

1.13

Regarding the Delegation and Supervision of Acupuncture Services to Unlicensed

Persons pursuant to section 12-200-114(1)(k), C.R.S.

This Rule is promulgated pursuant to sections 12-20-204, 12-200-114(1)(a) and (k), C.R.S. This Rule

applies to the delegation of services constituting the practice of acupuncture to a person who is not

licensed to practice acupuncture is not qualified for licensure as an acupuncturist, and is not otherwise

exempt pursuant to section 12-200-108(1) and (2), C.R.S.

Acupuncture Services that may be Delegated. Delegated acupuncture services should be limited

to routine, technical services that do not require the special skills of a licensed acupuncturist.

Services that may be delegated include but are not limited to:

Taking and monitoring vital signs;

Needle removal;

Moxa monitoring; and

Acupressure.

Acupuncture Services that may not be Delegated. A licensed acupuncturist should not delegate

an acupuncture service requiring the exercise of clinical judgement by the delegatee. Services

that may not be delegated include but are not limited to:

Diagnosis;

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gns;

Needle removal;

Moxa monitoring; and

Acupressure.

Acupuncture Services that may not be Delegated. A licensed acupuncturist should not delegate

an acupuncture service requiring the exercise of clinical judgement by the delegatee. Services

that may not be delegated include but are not limited to:

Diagnosis;

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Point location;

Needle insertion; and

Electrical stimulation.

Persons Who May Serve as Delagatee. The delegating acupuncturist must evaluate and

determine that the delegate has the necessary education, training, or experience to perform each

delegated acupuncture service. As part of his or her evaluation, the delegating acupuncturist

shall:

Personally assess and review copies of diplomas, certificates, or professional degrees

from bona fide training program(s) appropriate to the specific services delegated;

Perform over-the-shoulder, direct observation of the delegatee’s performance of any

acupuncture service prior to authorizing the delegate to perform the acupuncture service

outside of the delegating acupuncturist’s physical presence; and

Provide ongoing inspection, evaluation, advice, and control; and

Monitor the quality of the services provided by the delagatee.

Persons Who May Not Serve as Delagatee. An acupuncturist shall not delegate services to any

person who is otherwise qualified to be licensed as an acupuncturist but who is not licensed,

including, but not limited to:

Any person with an inactive, expired, revoked, restricted, limited, suspended, or

surrendered license to practice acupuncture;

Any person who meets all qualifications for acupuncture licensure but who is not licensed

in Colorado; or

Any person whose application for licensure in Colorado has been denied.

Exceptions.

This Rule does not apply to persons performing acts that do not constitute the practice of

acupuncture as defined by section 12-200-103(1), C.R.S.

, or

surrendered license to practice acupuncture;

Any person who meets all qualifications for acupuncture licensure but who is not licensed

in Colorado; or

Any person whose application for licensure in Colorado has been denied.

Exceptions.

This Rule does not apply to persons performing acts that do not constitute the practice of

acupuncture as defined by section 12-200-103(1), C.R.S.

This Rule does not apply to persons who are licensed, registered, or certified by

Colorado and who are acting within their scope of practice.

This Rule does not apply to any person who is otherwise exempt pursuant to section 12-

200-108(3), C.R.S.

Supervision. A delegating acupuncturist must be on the premises and readily available

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APPENDIX A

BALANCE BILLING NOTICE

PATIENT RIGHTS INFORMATION

Check the appropriate box:

☐

Your provider is proposing to use an out-of-network care provider in delivering your

health care service(s). This facility is in-network with your insurance but there may be

care providers involved in your care that are out-of-network.

☐

Your provider is proposing to deliver post-stabilization care at an out-of-network facility.

You have received emergency services at the out-of-network facility and are now

stabilized, but you may require additional health care services.

You are not required to consent to receive these services from the out-of-network care provider or

continue to receive post-stabilization care at an out-of-network facility. If you choose to proceed with the

proposed out-of-network care provider or facility you may be billed for costs detailed in the Good Faith

Estimate below. The additional costs you pay may not accrue toward insurance cost sharing or

deductibles.

You may choose to use an in-network provider from the list below or you may choose to transfer your

care to an in-network facility for post-stabilization services

choose to proceed with the

proposed out-of-network care provider or facility you may be billed for costs detailed in the Good Faith

Estimate below. The additional costs you pay may not accrue toward insurance cost sharing or

deductibles.

You may choose to use an in-network provider from the list below or you may choose to transfer your

care to an in-network facility for post-stabilization services. If you choose to proceed with an in-network

provider or transfer to an in-network facility, the cost will not exceed the amount allowed by your

insurance plan.

You chose to receive this Notice ☐ electronically or ☐ in paper form.

This notice must have been provided to you, either in paper or electronically, per your preference within

the following timeframes:

At least seventy-two hours in advance of the date of services, if the appointment was

scheduled at least seventy-two hours in advance;

At least three hours before the scheduled appointment, if the appointment was made less

than seventy-two hours in advance.

This is not a contract for services. Your provider is required to retain this form for seven years.

This form must be available to you in the 15 languages most common to the geographic region where

your provider is located, which include English, Spanish, Vietnamese, Chinese, Korean, Russian,

Amharic, Arabic, German, French, Nepali, Tagalog, Japanese, Cushite, and Persian.

BILLING ADVISEMENT

(choose applicable billing scenario)

☐

Out-of-Network Provider at In-Network Facility

Your provider is proposing to use an out-of-network care provider in delivering your service(s). That out-

of-network provider is/are:

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ian,

Amharic, Arabic, German, French, Nepali, Tagalog, Japanese, Cushite, and Persian.

BILLING ADVISEMENT

(choose applicable billing scenario)

☐

Out-of-Network Provider at In-Network Facility

Your provider is proposing to use an out-of-network care provider in delivering your service(s). That out-

of-network provider is/are:

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[PROVIDER NAME]

Description of service(s) to be provided by an in-network facility by an out-of-network provider:

[SERVICE]

You scheduled the service(s) on [DATE] at [TIME]. You are planning to receive the service(s) stated

above on [DATE] at [TIME]

Do you need prior authorization from your insurance company for the service(s) provided at this facility?

[Y / N]

Good Faith Estimate for the total cost of the service(s) to you, the patient:

[$]

Does this facility employ in-network care providers who provide the service(s) detailed above?

[Y / N]

If Yes, the in-network care provider(s) who provide the service(s) are:

[PROVIDER NAME]

NOTE: If there is no in-network provider to provide the service(s) at this in-network facility you cannot be

balanced billed for the services provided by the out-of-network provider. OR

☐

Post-Stabilization Services

Your provider is proposing to deliver post-stabilization care at an out-of-network facility. The out-of-

network facility is and/or the provider(s) is/are:

[FACILITY/PROVIDER NAME]

Description of post-stabilization service(s) to be provided by an out-of-network facility or provider:

[SERVICE]

You scheduled the service(s) on [DATE] at [TIME]. You are planning to receive the service(s) stated

above on [DATE] at [TIME].

Good Faith Estimate for the total cost of the service(s) to you, the patient:

[$]

I [PATIENT NAME] received this form at [TIME] on [DATE].

___________________________________________

SIGNATURE OF PATIENT

[TIME] and [DATE]

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ice(s) on [DATE] at [TIME]. You are planning to receive the service(s) stated

above on [DATE] at [TIME].

Good Faith Estimate for the total cost of the service(s) to you, the patient:

[$]

I [PATIENT NAME] received this form at [TIME] on [DATE].

___________________________________________

SIGNATURE OF PATIENT

[TIME] and [DATE]

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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.

Provider information, including, at a minimum: name, business address, and business telephone

number.

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.

For each such conviction or guilty plea, the provider shall provide, at a minimum:

The date that the final judgment of conviction or guilty plea was entered;

The nature of the offense or conduct that led to the final conviction or guilty plea;

The type, scope, and duration of the sentence or other penalty imposed, including

whether:

The provider entered a guilty plea or was convicted pursuant to a criminal

adjudication;

The provider was placed on probation and, if so, the duration and terms of the

probation and the date the probation ends; and,

The jurisdiction that imposed the final conviction or issued an order approving the

guilty plea.

e, and duration of the sentence or other penalty imposed, including

whether:

The provider entered a guilty plea or was convicted pursuant to a criminal

adjudication;

The provider was placed on probation and, if so, the duration and terms of the

probation and the date the probation ends; and,

The jurisdiction that imposed the final conviction or issued an order approving the

guilty plea.

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:

a conviction for or a guilty plea to a sex offense, as defined in section 16-11.7-102(3),

C.R.S., or a finding by the professional regulatory board or Director that the provider

committed a sex offense, as defined in as defined in section 16-11.7-102(3), C.R.S.; OR

a finding by a professional regulatory board or agency that the provider engaged in

unprofessional conduct or other conduct that is grounds for discipline under the part or

article of Title 12 of the Colorado Revised Statutes that regulates the provider’s

profession, where the failure or conduct is related to, includes, or involves sexual

misconduct that results in harm to a patient or presents a significant risk of public harm to

patients.

For each such final agency action by a professional regulatory board or agency the provider shall

provide, at a minimum:

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he provider’s

profession, where the failure or conduct is related to, includes, or involves sexual

misconduct that results in harm to a patient or presents a significant risk of public harm to

patients.

For each such final agency action by a professional regulatory board or agency the provider shall

provide, at a minimum:

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The type, scope, and duration of the agency action imposed, including whether:

the regulator and provider entered into a stipulation;

the agency action resulted from an adjudicated decision;

the provider was placed on probation and, if so, the duration and terms of

probation; and

the professional regulatory board or agency imposed any limitations on the

provider’s practice and, if so, a description of the specific limitations and the

duration of the limitations.

The nature of the offense or conduct, including the grounds for probation or practice

limitations specified in the final agency action;

The date the final agency action was issued;

The date the probation status or practice limitation ends; and

The contact information for the professional regulatory board or agency that imposed the

final agency action on the provider, including information on how to file a complaint.

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

__________

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

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This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.