Health Care Policy And Financing - Digest of Bills

Digest of Bills - 2002

HEALTH CARE POLICY AND FINANCING

S.B. 02-27 Medicaid - in-home support services - elderly, blind, and disabled - disabled children - review under provisions of sunset law. Requires the department of health care policy and financing ("department") to offer in-home support services ("services") as an option for eligible persons who receive home- and community-based services or who are eligible for the disabled children care program. Specifies that in-home support services will be provided to eligible persons who are willing to participate. Requires the department to seek any federal authorization that may be necessary to implement this service option. Requires the department to seek input from consumers of home- and community-based services and independent living centers and home- and community-based service providers regarding the design and implementation of the services. Specifies the requirements for a person to qualify and remain eligible for services.

Specifies that certain professional licensing requirements do not apply to a person who is directly employed by an in-home support service agency ("agency") to provide in-home support services and who is acting within the scope and course of such employment or is a family member providing in-home support services as authorized by the act. Requires agencies participating in the program to provide 24-hour back-up services to their clients. Specifies that an agency cannot discontinue a client under this program until either the client or the agency has secured other care for the client. Requires the medical services board to promulgate rules that establish guidance on how an agency can discontinue a client under the program, for the certification of in-home support service agencies, and the standards of care for the provision of services.

Repeals the authorization for in-home support services, effective July 1, 2008, and specifies that the services shall be subject to a sunset review prior to such repeal.

Specifies that the department is expected to receive $36,675 in federal funds for the implementation of the act.

APPROVED by Governor June 1, 2002
EFFECTIVE June 1, 2002

S.B. 02-197 Medicaid - home- and community-based services - persons with major mental illness - service costs - program continuation. Repeals the requirement that home- and community-based services shall only be offered to a person for whom the cost of services necessary to prevent nursing facility placement would not exceed the average cost of nursing home care. Requires the home- and community-based services for persons with major mental illnesses to meet aggregate federal waiver budget neutrality requirements.

Repeals the July 1, 2002, repeal date of the "Home- and Community-based Services for Persons with Major Mental Illnesses Act".

APPROVED by Governor June 1, 2002
EFFECTIVE June 1, 2002

H.B. 02-1027 Medicaid - case-mix reimbursement feasibility studies for home health care services, homemaker and personal care services, and alternative care facilities - appropriation. Requires the department of health care policy and financing ("department") to conduct a feasibility study with simulation of a case-mix reimbursement system for home health agencies and to conduct a feasibility study of a case-mix reimbursement system for reimbursing home- and community-based service providers for homemaker and personal care services and alternative care facilities. Specifies that the feasibility studies shall be voluntary on the part of providers and that the department shall determine how many providers may participate in each study. Allows the department to contract with an independent consultant to conduct the case-mix feasibility studies. Authorizes the department to hire an independent contractor and specifies that the independent contractor shall only be retained until the feasibility studies are completed. Requires the department to establish an advisory committee to provide input for purposes of the feasibility studies.

Stipulates that a case-mix reimbursement system shall only be instituted if the department and the joint budget committee of the general assembly ("JBC") determine, prior to implementation, that such a reimbursement system will not increase annual state expenditures for home health care and home- and community-based services, taking into account appropriate adjustments for cost of living.

Authorizes the department to accept and expend gifts, grants, and donations to conduct the feasibility studies and establishes the case-mix cash fund for this purpose. Specifies that if sufficient gifts, grants, and donations to support the feasibility studies are not obtained prior to July 1, 2004, then this act is repealed on July 1, 2004. Repeals the act, effective July 1, 2007, if sufficient gifts, grants, and donations to support the feasibility studies are obtained prior to July 1, 2004.

Appropriates $330,772 out of the case-mix cash fund for the implementation of the act and specifies that the department is expected to receive an additional $330,772 in federal funds for implementation of the act.

VETOED by Governor May 24, 2002

H.B. 02-1029 Medicaid - program of all-inclusive care for the elderly - authorization for expansion - feasibility study. Allows for the expansion of the program of all-inclusive care for the elderly ("PACE"). Requires the department of health care policy and financing ("department") to perform a feasibility study, conditioned on the receipt of sufficient gifts, grants, and donations, in order to identify viable communities that may support a PACE program site. Requires the department, consistent with the feasibility study, to use its best efforts to have in operation a specified number of new PACE program sites within the outlined time frames. Specifies reporting requirements for the department regarding the results of the feasibility study and the expansion of the PACE program sites.

Requires the department, in cooperation with the single entry point agencies, to develop and implement a coordinated plan to provide education about PACE program site operations. Authorizes each single entry point agency to designate case managers who have knowledge about the PACE program. Directs the state board of medical services to adopt rules concerning the program and training therefor.

Clarifies that nothing in the authorizing provisions of PACE requires the operator of a PACE program site to hold a certificate of authority as a health maintenance organization.

APPROVED by Governor May 31, 2002
EFFECTIVE May 31, 2002

H.B. 02-1039 Medicaid - home- and community-based services - consumer-directed care for the elderly - appropriation. Requires the department of health care policy and financing ("department") to implement a consumer-directed care program ("program") for the elderly that allows eligible persons to receive a direct payment through a voucher to purchase home- and community-based services. Specifies the eligibility criteria for participation in the program and the services participants can receive under the program.

Specifies that the voucher amount will be based on the person's historical utilization of home- and community-based services or the single entry point agency's care plan for the person. Stipulates that while a person is participating in the program that person is ineligible to receive a home care allowance.

Requires the department to develop the accountability requirements necessary to safeguard the use of public dollars, to promote effective and efficient service delivery under the program, and to monitor the safety and welfare of program participants.

Directs the medical services board to adopt rules for the implementation and administration of the program.

Appropriates $40,558 and 0.8 FTE to the department to implement the act. Specifies that the department is expected to receive an additional $77,262 in federal funds for the implementation of the act.

Makes the act contingent upon the passage of and savings realized from House Bill 02-1292.

APPROVED by Governor May 30, 2002
EFFECTIVE May 30, 2002
NOTE: House Bill 02-1292 was signed by the Governor on May 30 , 2002, and the fiscal estimate shows sufficient general fund savings.

H.B. 02-1093 Public assistance - recovery of overpayments - when collection efforts cease. Eliminates language that allowed the department of human services and county departments of social services to collect welfare overpayments regardless of fault, including pursuing collections from adult children who, in their youth, were members of a household that received public assistance under the aid to families with dependent children program or temporary assistance for needy families and whose caretaker relative obtained welfare overpayments.

Directs that recovery of welfare overpayments shall be pursued first from the caretaker relative who fraudulently obtained public assistance or who was the direct payee of the overpayments. Provides that overpayment collection activities against the other overpaid members in the assistance unit shall be suspended. States that, on March 26, 2002, the department and the county departments shall cease any collection efforts being made against the children of an assistance unit in which public assistance was overpaid or fraudulently obtained by a caretaker relative who has been located by the department or a county department. Allows the department and the county departments to elect not to attempt recovery where the overpayment amount is less than $35. Allows the department and county departments, consistent with the 6-year time limitation for execution on judgments involving state debt, to decide that it is no longer cost-effective to continue to pursue recovery of an overpayment that is $35 or more.

Specifies that the department and the county departments shall not pursue overpayment collection activities against children who have been part of a Colorado works program assistance unit.

APPROVED by Governor March 26, 2002
EFFECTIVE March 26, 2002

H.B. 02-1127 Medicaid - home- and community-based services - elderly, blind, and disabled - costs. Repeals the requirement that home- and community-based services shall only be offered to a person for whom the cost of services necessary to prevent nursing facility placement would not exceed the average cost of nursing facility care. Requires the home- and community-based services for the elderly, blind, and disabled to meet aggregate federal waiver budget neutrality requirements.

APPROVED by Governor April 3, 2002
EFFECTIVE April 3, 2002

H.B. 02-1155 Children's basic health plan - prenatal and postpartum care for pregnant women - appropriation. Subject to receipt of a waiver from the federal department of health and human services, adds prenatal care and postpartum care to the children's basic health plan for pregnant women who are not eligible for medicaid. Covers pregnant women whose income is greater than the income level for the baby and kid care program (133% of the federal poverty level) up to the income level for the children's basic health plan (185% of the federal poverty level). Covers postpartum care for 60 days after the birth of the child. Provides that, upon birth, the child is automatically enrolled in the children's basic health plan. Exempts a pregnant woman from paying the annual enrollment fee for the children's basic health plan.

Increases by $7,700,000 the amount of moneys the children's basic health plan receives out of the tobacco litigation settlement moneys. Provides that if the tobacco settlement moneys are insufficient to fund the children's basic health plan amounts out of the cash fund, the shortfall shall be taken out of the tobacco settlement trust fund. Requires separate reporting of the amounts allocated for the children's basic health plan and the prenatal and postpartum care program and subsequent review of whether the prenatal and postpartum care portion should continue to be paid out of the tobacco settlement moneys or out of general fund revenues. Requires prenatal and postpartum primary health care providers to implement policies regarding the integration of evidence-based tobacco use treatments into the health care delivery system, including assessment of tobacco use and exposure to second-hand smoke, education on tobacco use during pregnancy and postpartum, and referral to cessation services.

Appropriates $7,700,000 out of the tobacco litigation settlement cash fund to the children's basic health plan. Appropriates $6,321,561 from the children's basic health plan trust to the department of health care policy and financing to implement the act. Specifies that the department of health care policy and financing is expected to receive an additional $11,740,044 in federal funds for implementation of the act. Appropriates $26,163 to the department of health care policy and financing, department of human services medicaid-funded programs, office of information technology services - medicaid funding and $74,750 to the department of human services, office of information technology services, to implement the act.

APPROVED by Governor May 24, 2002
EFFECTIVE May 24, 2002

H.B. 02-1232 X-ray inspection and certification fees. Increases from $50 to $80 the annual fee for individuals who inspect and certify machines that are the source of ionizing radiation ("x-ray machines"). Increases from $30 to $50 the fee for affixing a certification or noncertification sticker to an x-ray machine.

APPROVED by Governor May 24, 2002
EFFECTIVE May 24, 2002

H.B. 02-1282 Medicaid - home- and community-based services - persons with brain injury. Requires the department of health care policy and financing ("department") to seek any necessary amendments to the current federal waiver for the home- and community-based services program for persons with brain injury ("program") to allow services to be provided to eligible persons on a supportive care campus. Modifies the definition of "eligible person" under the program to include a person who is in need of specialized care provided in a nursing facility in lieu of a hospital. Specifies that the implementation of provisions relating to supported living provided on a supportive care campus are conditioned upon the approval of necessary waiver amendments by the federal government.

Requires the medical services board ("board") to promulgate rules to set tiered per diem rates for the services provided on a supportive care campus and any rules necessary for quality assurance, and specifies that the rules shall include certification of supportive care campuses. Requires the board to consider the medical and cognitive needs of eligible persons being served on the supportive care campus when structuring the tiered per diem rates.

APPROVED by Governor April 3, 2002
EFFECTIVE April 3, 2002

H.B. 02-1292 Medicaid - statewide managed care system - appropriations - adjustment to long bill. Repeals the requirement that the medicaid statewide managed care system ("system") cover 75% of the medicaid population on a statewide basis and specifies that the system shall be implemented to the extent possible. Specifies that the system shall not include services delivered under the residential child health care program and long-term care services, except for specified long-term care programs. Repeals the executive director's ability to implement certain effective statewide pilot projects.

Repeals the annual cost savings reporting requirements of the department of health care policy and financing ("department"), the formulas for the calculation of those cost savings, and the method of appropriating the cost savings. Repeals the requirement that the department restrict spending if the cost savings appropriated are not actually realized. Repeals the grant program to assist essential community providers to serve the medically indigent population.

Effective on and after July 1, 2003, requires managed care organizations ("MCOs") contracting with the department to meet financial stability criteria established by the division of insurance and to certify, as a condition of entering into a contract with the department, that the capitation rates set forth in the contract are sufficient to assure the financial stability of the MCO with respect to the delivery of services under the medicaid program. Effective on and after July 1, 2003, requires the MCO to certify that the capitation rates set forth in the contract comply with all applicable federal and state requirements that govern those rates. Specifies the certification requirements of an MCO providing services under the PACE program. Requires the department, effective on and after July 1, 2003, to certify that the capitation payments in the contract between the department and the MCOs comply with all applicable federal and state requirements that govern those capitation payments. Specifies that certification by a qualified actuary will be conclusive evidence that the department has correctly calculated the direct health care cost of providing the same services to an actuarially equivalent Colorado medicaid population group. Specifies that, effective July 1, 2003, the capitation payments certified by the qualified actuary shall not be subject to any dispute resolution process, including any such process set forth in any settlement agreement entered into prior to this act.

Implements a new rate-setting process in which the department, in cooperation with the MCOs, is required to set a timeline for the rate-setting process for the following fiscal year's rates. Requires the department to identify and make available to the MCOs the base data for the base calculation. Specifies that for capitation payments effective on and after July 1, 2003, the department is required to recalculate the base calculation every 3 years and annually trend the base calculation for the years in which the base calculation is not recalculated.

Requires an MCO to notify all recipients involved in disputes with the MCO of the right to seek administrative review of any adverse decision by the MCO. Repeals a provider's ability to request a hearing through the department's aggrieved provider appeal procedures regarding a dispute between nursing facilities, pharmacies, and MCOs concerning providing prescription drug benefits. Repeals provisions relating to MCOs contracting with essential community providers.

Specifies that nothing under the medicaid statewide managed care system creates an entitlement to an MCO to contract with the department. Changes the time frame for a recipient to respond regarding the selection of an MCO or primary care physician from 20 to 30 days. Changes the notification requirements allowing the department to send a single notice instead of 2 notices to the recipient.

Allows the department to contract with an independent facilitator to ensure that consumers have informed choice about their managed care options. Requires the department to establish the position of ombudsman for medicaid managed care to act as an enrollee's representative, at the enrollee's request, in resolving complaints and grievances with an MCO. Specifies that the provisions of the act are applicable to contracts issued, renewed, or amended after July 1, 2002.

Makes various adjustments to the 2002 general appropriations act to reflect the modifications made to the statewide managed care system in the act.

APPROVED by Governor May 30, 2002
EFFECTIVE July 1, 2002