S.B. 95-78 Services administered by the department of health care policy and financing - revision to statutes - appropriation. Makes the following revisions to the Colorado medical assistance program:
Sections 1, 2, and 3. Amends statutory sections concerning final agency action of the department of health care policy and financing with respect to agency decisions.
Section 4. Makes changes in the home care allowance program by requiring the medical services board to adopt a method for determining the amount of an award for home care allowance that corresponds to a person's unmet need for paid care. Authorizes the department of health care policy and financing to implement pilot programs to test the feasibility of using alternative methods for determining a person's unmet need for paid care and the amount of an award based on such need.
Sections 5, 6, and 25 through 50. Changes the term used to describe service providers under the medical assistance program from "vendor" to enrolled "provider". In addition, defines "false representation" for the purposes of determining whether the state has made an overpayment to a provider and whether the state may recover the overpayment.
Section 7. Gives managed care providers similar recovery rights as the department of health care policy and financing, including the right to recover from third parties. Specifies that the recovery rights of the state take precedence over the right of a managed care provider.
Section 8. Authorizes the department of health care policy and financing to pass payments through to nursing facility providers in advance of the providers' implementation of the automated minimum data-set system, in accordance with the federal "Omnibus Budget Reconciliation Act of 1987".
Section 9. Separates statutory language concerning co-payments required from medical assistance recipients from language concerning third-party payments.
Section 10. Eliminates the July 1, 1995, repeal of the program of all-inclusive care for the elderly (PACE), which program is based on medicare and medicaid waivers under which public or nonprofit private community-based organizations provide comprehensive health care services on a capitated basis to frail elderly who are at risk of institutionalization.
Section 11. Eliminates the July 1, 1995, repeal of the child statutory provisions concerning medical assistance reimbursement to residential care facilities for the provision of medically necessary services.
Sections 12 and 13. Eliminates intensive supervision of foster care children as a medical assistance service for persons eligible for the home and community-based services program for persons living with AIDS (HCBS-PLWA) and deletes the definition of hospice services under HCBS-PLWA, which services had been previously eliminated. Includes electronic monitoring and nonmedical transportation as services under HCBS-PLWA.
Sections 14 and 15. Transfers responsibility for ensuring that school entry immunization requirements are met from the department of public health and environment to the department of health care policy and financing. Authorizes the department of health care policy and financing to contract with the department of public health and environment to enforce the school entry immunization requirements. Provides that the communicable diseases specified by the state board of health for child immunization are to be based on recommendations from the U.S. department of health and human services or the American academy of pediatrics.
Section 16. Deletes the term "single entry point" in reference to the managed mental health care pilot program and continues the study of the prepaid capitated system. Extends the automatic sunset date for the pilot program from July 1, 1996, to July 1, 1997. Requires the department of health care policy and financing and the department of human services to submit a final report to the general assembly by January 1, 1997, addressing the outcome of the pilot program and making various recommendations with respect to the implementation of a prepaid capitated system of comprehensive mental health services on a statewide basis. Requires the department of health care policy and financing to begin a statewide prepaid capitated system by July 1, 1997, or within 90 days of receipt of necessary federal waivers, whichever occurs later, but conditions the implementation of the statewide system upon receipt of the necessary federal waivers.
Section 17. Requires the executive director of the department of health care policy and financing to reimburse certified family planning clinics for medical or diagnostic services that are covered under the "Colorado Medical Assistance Act".
Section 18. Changes the method for determining the protection of income and resources for a community spouse by eliminating the current statutory limit and replacing the limit with the federal maximum resource allowance under the federal medicaid program.
Sections 19 through 24. Authorizes the department of health care policy and financing to implement a private-public partnership to finance long-term health care in the state. Requires the department to work with the division of insurance to create a private-public partnership through the availability of long-term care insurance policies that result in reducing the state's dependence on the medial assistance program to finance such care. Encourages the department of health care policy and financing to implement a public education and awareness program with respect to the availability of such long-term care plans and authorizes the department to finance the program with private contributions and grants or fees imposed in connection with conducting any public education-awareness training program or seminar. Includes certain evaluation and reporting requirements based on the availability of funds for an independent evaluation. Requires the department of health care policy and financing to seek necessary federal waivers in connection with any requirement that long-term care policies be counted as resources in determining eligibility for medical assistance. Allows the department of health care policy and financing to pay the required premium for a person who allowed their long-term care policy to lapse if the person is otherwise eligible for medical assistance.
Lists certain mandated provisions to be included in long-term health care insurance plans. Requires that on or after January 1, 1997, all insurance carriers that offer long-term care insurance coverage to Colorado residents actively offer the choice of a basic long-term care plan or a standard long-term care plan in addition to any other plan. Creates a long-term care benefit plan advisory committee that is responsible for making recommendations to the commissioner of insurance concerning long-term care policies.
Section 51. Appropriates $206,902 to the department of health care policy and financing; decreases the appropriation made to the department in the annual general appropriation act by $21,498; and appropriates $43,669 to the department of regulatory agencies, for allocation to the division of insurance, for the implementation of this act.
APPROVED by Governor May 25, 1995
EFFECTIVE May 25, 1995
H.B. 95-1287 Birth-related cost recovery program - liability of noncustodial parents - collection of debts - appropriation. Creates the birth-related cost recovery program to be administered by the department of health care policy and financing. Requires the department to obtain any necessary federal waivers. If no federal waivers are necessary, requires the program to be implemented on or before January 1, 1996. If federal waivers are necessary, requires the program to be implemented on or before 6 months after the earliest date allowed under the waiver. Directs the department of health care policy and financing and the department of human services to work cooperatively to obtain any necessary waivers and to implement the program.
Under the program, makes each noncustodial parent jointly and severally liable for reimbursement to the state for birth-related medical costs for the birth of a noncustodial parent's natural child expended under the "Colorado Medical Assistance Act" or the "Reform Act for the Provision of Health Care for the Medically Indigent". Recoverable birth-related medical costs shall constitute a continuing debt owed to the state in the base amount of $3,800. Requires the base amount to be adjusted annually for inflation and specifies that the debt shall also include collection costs and interests. Specifies that liability for the debt shall be in effect whenever the noncustodial parent's income, property, and resources are sufficient to meet the cost of covering the debt, regardless of any intervening period of insufficiency. Exempts noncustodial parents who voluntarily acknowledge paternity and are current in the payment of child support obligations from the requirement to repay the debt. Requires the department to adopt an appellate procedure for any person who wishes to contest the assessment of a debt under the program.
Authorizes the department of health care policy and financing to utilize all debt collection methods statutorily available to the department of human services for the collection of child support and public assistance debts. Directs the department of health care policy and financing to adopt rules and regulations that include: A method for determining when a debt has been incurred; criteria for determining when it is cost-effective to pursue collection; and, when a debt is deemed reasonably collectible, a requirement that a liable noncustodial parent enter into a repayment agreement that amortizes the debt over a period not to exceed 7 years. Requires the department to annually reassess a noncustodial parent's ability to pay if such agreement reflects a reduced payback amount. Directs the department to amend the agreement to reflect an increased payback amount up to the full amount of the debt based on a noncustodial parent's improved financial circumstances. Authorizes the department to enter into contracts with public and private entities to facilitate the collection of debts under the program. Authorizes the department to institute or intervene in legal proceedings against a noncustodial parent in the event of refusal to pay or default under a repayment agreement. Specifies that court costs shall be assessed against a noncustodial parent if the court finds in favor of the state. Provides for subrogation of the state's interest to any rights that a liable noncustodial parent may have to obtain reimbursement from a third party for birth-related costs that constitute a debt under the program. Specifies obligations that take priority over a debt incurred under the program. Authorizes the department of human services to adopt rules and regulations. Repeals the program on June 30, 1999.
Appropriates $164,086 and 1.0 FTE to the department of health care policy and financing, of which $15,594 and 0.2 FTE is appropriated to the department of law for the implementation of the act.
APPROVED by Governor June 5, 1995
EFFECTIVE July 1, 1995
H.B. 95-1312 Hospital efficiency and cooperation act - department transfer. Transfers the responsibility for the functions and duties of the cooperative health care agreements board pursuant to the "Hospital Efficiency and Cooperation Act" from the department of local affairs to the department of health care policy and financing.
APPROVED by Governor May 16, 1995
EFFECTIVE May 16, 1995
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