Health Care Policy And Financing - Digest of Bills

Digest of Bills - 2004

HEALTH CARE POLICY AND FINANCING

S.B. 04-28 Native Americans - federal approval - substance abuse treatment - appropriation. Clarifies that the department of health care policy and financing shall seek federal approval to provide substance abuse treatment to native Americans.

Appropriates $21,741 from gifts, grants, and donations in the native American substance abuse treatment cash fund and $21,741 in federal funds to pay for preparation of the documents necessary to apply for the federal approval.

APPROVED by Governor May 21, 2004
EFFECTIVE May 21, 2004

S.B. 04-29 Medically fragile individuals - alternative care planning - information - exceptions. Requires specified care plans within the state's medicaid program and programs for the developmentally disabled to include a process by which an eligible individual ("individual") may receive necessary care, which may include respite care, if the individual's family or care provider is unavailable due to an emergency situation or to unforeseen circumstances. Requires the care planning entity to inform the individual's family or care provider of these alternative care provisions at the time the care plan is initiated.

Specifies that these alternative care provisions shall not apply to individuals residing in alternative care facilities or nursing facilities. Clarifies that these alternative care provisions do not require a community centered board to provide services that the board is not otherwise required to provide to the individual receiving services.

Amends the definition of medical foster care to include medically fragile children who are dependent on tracheotomy tubes.

APPROVED by Governor April 20, 2004
EFFECTIVE August 4, 2004
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

S.B. 04-138 Medicaid - monthly fee for children's waiver programs - repeal - appropriation. Repeals the department of health care policy and financing's authority to charge a monthly fee to families whose children are enrolled in either the children's home- and community-based services waiver program or the children's extensive support waiver program.

Makes various adjustments to the 2003 and 2004 general appropriations acts to reflect the repeal of this fee authority.

APPROVED by Governor May 21, 2004
EFFECTIVE May 21, 2004

S.B. 04-177 Medicaid - home- and community-based services - autism - funding. Establishes the "Home- and Community-based Services for Children with Autism Act" ("act") and requires the department of health care policy and financing ("department") to seek the federal authorization necessary to implement the provisions of the act. Defines which children are eligible to receive the home- and community-based services ("services") and what services shall be provided under the act.

Specifies that no child may receive services in an amount in excess of $25,000 annually. Requires the department to utilize the services of existing service provider agencies and limits the amount a service provider agency may retain for administrative costs. Limits the provision of services under the act to available appropriations from the Colorado autism treatment fund ("fund"), which is established. Requires the state department to develop the service provisions and a care planning process in consultation with parents of children with autism and medical professionals who have expertise in treating children with autism.

Establishes 2 alternative funding sources:

● If House Bill 04-1421 becomes law, beginning at the end of fiscal year 2004-05 and for each fiscal year thereafter allocates to the fund up to $1,000,000 from unexpended tobacco settlement moneys.

● If House Bill 04-1421 does not become law, beginning in fiscal year 2005-06 allocates to the fund up to $1,000,000 from tobacco settlement moneys currently allocated for tobacco education, prevention, and cessation.

Sets forth varying effective dates for a number of sections of the act contingent on the passage of House Bill 04-1421.

APPROVED by Governor May 27, 2004
EFFECTIVE January 1, 2005
NOTE: (1) This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.
(2) House Bill 04-1421 was approved in part and vetoed in part by the Governor, June 4, 2004.

S.B. 04-206 Medicaid - pediatric hospice care services - appropriation. Requires the department of health care policy and financing ("department") to seek the appropriate federal authorization, conditioned on the receipt of gifts, grants, or donations sufficient to provide for the state's administrative costs of preparing and submitting the request, for hospice care services ("services") for children eligible under the state's medicaid program. Specifies that the services shall include but need not be limited to: Respite care; expressive therapies; palliative care from the time of diagnosis of a potentially life-threatening illness; and continuum of care through the coordination of services, which may include skilled, intermittent, and around-the-clock nursing care. Authorizes the department to seek federal approval for modifications to the provision of hospice care for adults who are eligible for the state's medicaid program. Authorizes the department to seek gifts, grants, and donations, and creates the pediatric hospice care cash fund for receipt of any funds received.

Specifies the federal medicaid requirements for the eligibility of and election for hospice care from which the department shall seek an exemption. Requires the department, in any application for federal authorization under the act, to retain bereavement services to the extent available under federal law.

Requires the department to notify the joint budget committee of the general assembly ("JBC") of the extent to which the department receives federal approval for pediatric hospice care services, in order for the JBC to review the approved budget neutrality analysis for such services prior to the department's implementation.

Appropriates $22,000 from the pediatric hospice care cash fund to the department, and anticipates receipt of federal matching funds in the same amount, for the implementation of the act.

APPROVED by Governor May 27, 2004
EFFECTIVE May 27, 2004

H.B. 04-1027 Comprehensive primary and preventive care grant program - advisory council. Requires the comprehensive primary and preventive care grant program's advisory council ("advisory council") to review and make recommendations to the department of health care policy and financing ("department") on the protocols related to awarding grants to qualified providers and to provide feedback to the department on the design and content of the grant application and the grant application and evaluation processes. Repeals the advisory council's role regarding making recommendations on the award of service grants to qualified providers.

APPROVED by Governor March 9, 2004
EFFECTIVE August 4, 2004
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 04-1058 Medicaid - medical assistance eligibility determinations - report - county recovery. Authorizes the department of health care policy and financing ("department") to accept medical assistance applications and to determine medical assistance eligibility. Authorizes the department to designate the private service contractor that administers the children's basic health plan, Denver health and hospitals, and a hospital that is designated as a regional pediatric trauma center each to accept medical assistance applications and to determine medical assistance eligibility. Requires the department to report on the progress of these additional medical assistance sites.

Prohibits the department from pursuing recovery from a county for the cost of medical services provided to a person who has been incorrectly determined eligible for medical assistance by that county or any other entity. Repeals this prohibition, effective July 1, 2008.

APPROVED by Governor April 2, 2004
EFFECTIVE April 2, 2004

H.B. 04-1075 High-risk pregnant women - federal approval for extension of substance abuse treatment - appropriation. Directs the department of health care policy and financing ("department") to seek federal approval to extend to 12 months following a pregnancy substance abuse treatment services for high-risk pregnant women who are eligible for services under the medical assistance program.

For implementation of the act, increases the appropriation to the department for the high-risk pregnant women program by $95,805, of which $47,902 shall be a transfer from the department of human services substance abuse block grant program and $47,903 shall be from federal funds. Transfers the $95,805 appropriation from the department to the department of human services.

APPROVED by Governor May 21, 2004
EFFECTIVE May 21, 2004

H.B. 04-1219 Medicaid - home- and community-based services for the elderly, blind, and disabled - transition - appropriation. Authorizes community transition services ("services") for elderly, blind, or disabled persons who are receiving home- and community-based services. Specifies that the services shall not exceed $2000 per eligible person unless otherwise authorized by the department of health care policy and financing ("department") and shall be administered by a transition coordination service agency.

Appropriates $21,924 and 0.4 FTE to the executive director's office of the department and decreases the department's medical services premiums appropriation by $79,649 for the implementation of the act.

APPROVED by Governor May 21, 2004
EFFECTIVE July 1, 2004

H.B. 04-1220 Transportation services - administrative cost. Changes transportation from a service to an administrative cost under the "Colorado Medical Assistance Act".

APPROVED by Governor April 5, 2004
EFFECTIVE July 1, 2004

H.B. 04-1264 Payment schedule - no interruption - exception. Provides that the department of health care policy and financing ("department") shall not intentionally interrupt its normal provider payment schedule unless it receives a notice from the director of the office of state planning and budgeting and the state controller that there is a possibility that adequate cash will not be available to make payments to providers and for other state expenses. If the department does interrupt its payment schedule because of such notice, requires the department to notify the joint budget committee of the general assembly and any affected providers of its intent.

APPROVED by Governor April 13, 2004
EFFECTIVE April 13, 2004

H.B. 04-1265 Medicaid - community mental health services - transfer of administration - appropriation. Transfers the administration of community mental health services to medical assistance recipients from the department of human services to the department of health care policy and financing ("department"), including all positions of employment and items of property related to the powers, duties, and functions of administering these services. Specifies that the administration of medicaid community mental health services by the department includes program approval, program monitoring, and data collections. Authorizes the department to seek federal approval for any necessary changes to the state's waiver that authorizes the statewide system of community mental health care to reflect the provisions of this act. Authorizes the department to limit a recipient's freedom of choice with respect to a provider of mental health services and to restrict reimbursements for mental health services to designated and contracted agencies.

Specifies that the administration of the provision of mental health services to persons receiving services pursuant to Arevalo v. Colorado Department of Human Services, Case No. 81 CV 6961, in the district court for the city and county of Denver, and the administration of the mental health institutes shall remain the responsibility of the department of human services.

Requires the department and the department of human services jointly to produce a document to assist mental health consumers and advocates and providers that participate in Colorado's publicly funded mental health system to understand the respective roles of each department in the provision of mental health services and each department's ability to provide high quality and accessible mental health services. Specifies how the document shall be developed and made available to the public. Requires the state auditor, when conducting an audit of the statewide mental health system, to evaluate the coordination of services between the department and the department of human services and the impact of the administration of the mental health system on the quality of care within the statewide mental health system.

Makes various adjustments to the 2003 long bill for the implementation of the act.

APPROVED by Governor April 6, 2004
EFFECTIVE April 6, 2004

H.B. 04-1284 Providers - audit - overpayments. Establishes standard procedures for a review or an audit of a provider under the "Colorado Medical Assistance Act". Authorizes the department of health care policy and financing to contract with a qualified agent to conduct a review or an audit of a provider, and establishes requirements for such a contract.

Specifically includes laboratories certified by the federal government to perform high complexity testing in the definition of "provider".

APPROVED by Governor May 28, 2004
EFFECTIVE September 1, 2004

NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 04-1415 Nursing facilities - state nursing facility service program - provider fees - grant program - repeal - appropriation. Specifies that the state nursing facility service program shall be subject to available appropriations by the general assembly and may receive moneys other than those from the nursing facility cash fund, which is repealed. Repeals the nursing facility provider fee and the nursing facility quality of care grant program.

Appropriates $838,528 from the general fund to the department of health care policy and financing for the state nursing facility service program.

APPROVED by Governor April 21, 2004
EFFECTIVE July 1, 2004

H.B. 04-1416 FY 2004-05 budget reduction bill - medicaid - breast and cervical cancer prevention and treatment program - appropriation. Eliminates the requirement that the general assembly appropriate 50 % of the state costs of the breast and cervical cancer prevention and treatment program from the general fund in state fiscal year 2004-05.

Appropriates $1,015,048 from the breast and cervical cancer prevention and treatment fund to the department of health care policy and financing for the implementation of the act.

APPROVED by Governor May 12, 2004
EFFECTIVE July 1, 2004

H.B. 04-1438 Indigent care - data submission - hospital reimbursement - qualification. Directs the department of health care policy and financing ("department") to require any hospital provider who may receive payment under the Colorado indigent care program ("program") annually to submit data relating to the hospital's number of medicaid-eligible in-patient days. Requires the department to include this information by hospital in the department's annual budget request to the joint budget committee of the general assembly and the annual program report.

Specifies that in order to qualify for the program's payment formula disproportionate share hospital factor as described in rule by the medical services board, a hospital provider's percent of medicaid-eligible in-patient days relative to total in-patient days shall be equal to or exceed one standard deviation above the mean.

APPROVED by Governor May 28, 2004
EFFECTIVE July 1, 2004

H.B. 04-1447 Children's basic health plan - enrollment - children disenrolled from medicaid - funding - appropriation. Requires the department of health care policy and financing ("department") to provide a child who is no longer eligible for the state's medicaid program due to the implementation of Senate Bill 03-176 with notice of the opportunity to choose to be enrolled in the children's basic health plan ("plan") prior to the child's disenrollment from medicaid. Specifies that if a child's parent or legal guardian chooses to have the child enrolled in the plan, affirms income eligibility, and agrees to any applicable cost-sharing, the department shall enroll the child with no lapse in coverage between the child's enrollment in medicaid and the child's enrollment in the plan. Specifies that the child shall be eligible for the plan for a period of 12 months.

Establishes 2 alternative funding sources:

● If House Bill 04-1421 becomes law, makes various adjustments to the 2004 long bill for the plan.

● If House Bill 04-1421 does not become law, beginning in fiscal year 2004-05 allocates to the children's basic health plan trust up to $250,000 from tobacco settlement moneys currently allocated to the tobacco education, prevention, and cessation grant program. Makes various adjustments to the 2004 long bill to reflect this funding option.

Sets forth varying effective dates for a number of sections of the act contingent on the passage of House Bill 04-1421.

APPROVED by Governor June 4, 2004
EFFECTIVE June 4, 2004
NOTE: House Bill 04-1421 was approved in part and vetoed in part by the Governor June 4, 2004.