Health Care Policy And Financing - Digest of Bills

Digest of Bills - 2005

HEALTH CARE POLICY AND FINANCING

S.B. 05-102 Medicaid - multistate prescription drug purchasing pool - preferred drug list - appropriation. Requires the department of health care policy and financing ("department") to apply for the necessary federal authorization to enter into a multistate prescription drug purchasing pool ("purchasing pool") for the benefit of the state's medicaid recipients. Requires the department to contract, through a competitive bidding process, with one or more entities capable of administering a preferred drug list and a supplemental rebate program for purposes of the purchasing pool. Requires the department to have the contract in place on or before February 1, 2006.

Requires the executive director to promulgate rules that establish an evidence-based preferred drug list that meets the federal requirements for allowing the state to enter into a purchasing pool for medicaid recipients unless a bill establishing a preferred drug list is enacted in the first regular session of the 65th general assembly and becomes law. Specifies that a preferred drug list established by rule shall exempt the following from the prior authorization process: Antiretroviral medications for AIDS or HIV; medications for the treatment of biologically based mental illness as defined in section 10-16-104 (5.5), C.R.S.; biologics, including treatments for cancer and cancer-supportive care and dialysis and dialysis-supportive care; all medications, without restriction, for the treatment of mental illness; and medications for the treatment of cardiovascular disease. Requires the executive director to consider the differences in drug metabolism in minority populations when considering which drugs to include on the preferred drug list and which drugs to exempt from the prior authorization process. Allows the department to purchase prescription drugs outside of the purchasing pool agreement if the department is able to at a lower price.

Contingent on House Bill 05-1243 becoming law, appropriates $307,376 and 1.0 FTE to the department for the implementation of the act. Specifies that of that amount, $153,688 shall be from the general fund and an equal amount is anticipated to be received in federal matching funds.

VETOED by Governor June 1, 2005

S.B. 05-162 Prescription drugs - dual medicaid and medicare eligibles. If a medicaid recipient is enrolled in a prescription drug benefits plan under medicare, provides that prescribed drugs are not a covered benefit for the recipient unless a prescribed drug is not covered by the medicare prescription drug benefit plan and federal financial participation is available.

APPROVED by Governor April 5, 2005
EFFECTIVE August 8, 2005
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

S.B. 05-173 Community long-term care services - pilot program - advisory committee. Contingent on the receipt of sufficient gifts, grants, or donations, requires the department of health care policy and financing ("state department") to convene an advisory committee ("committee") no later than August 15, 2005, to assist in the creation of a community long-term care delivery system. Specifies the members of the committee and the charge of the committee. Contains a reporting requirement for the committee and the state department regarding the committee's recommendations.

Requires the state department to accept proposals for and possibly approve a 3-year coordinated care pilot program ("pilot program") for community long-term care services. Specifies the community and population components of the pilot program. Grants the state department flexibility in determining the reimbursement for acute care providers, long-term care community providers, and class I nursing facilities under specified circumstances. Grants the medical services board rule-making authority for implementation of the act. Authorizes the state department to use savings in the medical services premiums appropriations to fund the pilot program.

APPROVED by Governor April 5, 2005
EFFECTIVE April 5, 2005

S.B. 05-211 Children's basic health plan trust - transfer. Requires the state treasurer and the controller to make a one-time transfer of $8,100,000 from the children's basic health plan trust to the state general fund.

Makes the act contingent upon the passage of House Bill 05-1262.

APPROVED by Governor April 29, 2005
EFFECTIVE April 29, 2005
NOTE: House Bill 05-1262 was signed by the governor June 2, 2005.

S.B. 05-221 Medicaid and children's basic health plans - HIFA waiver - public meetings - approvals - appropriation. Requires the state department of health care policy and financing ("state department") to prepare and submit to the health and human services ("HHS") committees of the house of representatives and senate a waiver under the federal health insurance flexibility and accountability demonstration program to permit the state to create a new service delivery or purchasing system to better serve specified children and adults under the medical assistance program or the children's basic health plan. Specifies additional information to be included in the waiver or given to the HHS committees.

Requires the joint HHS committees to conduct at least 4 public hearings on the waiver in various areas of the state. If, within 60 days after the submission of the waiver, the HHS committees approve the waiver, allows the joint budge committee ("JBC") to conduct hearings on the waiver. If, within 15 days after the approval of the waiver by the HHS committees, the JBC approves the waiver, requires the state department to submit the waiver to the federal government. If the federal government suggests or requires changes to the waiver, requires the HHS committees and the JBC to approve the amended waiver.

Specifies that, if the waiver is implemented, the state auditor's office shall oversee the evaluation of the waiver. Specifies the requirements of the evaluation.

Appropriates $20,000 to the general assembly for implementation of the act. Makes the act contingent on House Bill 05-1243 becoming law.

APPROVED by Governor May 26, 2005
EFFECTIVE May 26, 2005
NOTE: House Bill 05-1243 was signed by the governor June 3, 2005. For more information on the effective date see section 4 of this act.

H.B. 05-1015 Medicaid - outpatient substance abuse treatment - state auditor report. Adds outpatient substance abuse treatment as an optional service to the medical services program ("program"). Requires the state auditor, by January 1, 2011, to report to the legislative audit committee on whether the provision of substance abuse treatment services has resulted in an increase or decrease in the overall cost of the program. If, on or before March 31, 2011, the legislative audit committee adopts a resolution finding that the provision of substance abuse treatment resulted in an increase in cost to the program, repeals the provisions adding it to the program, effective July 1, 2011.

APPROVED by Governor May 26, 2005
EFFECTIVE May 26, 2005

H.B. 05-1017 Medicaid - prohibited provider referrals. Restructures the existing statute regarding prohibited provider referrals under the state's medicaid program and makes changes to conform to federal law and regulation. Specifies that if a financial relationship between an entity, which delivers designated health services, and a provider is not prohibited by federal law then the financial relationship is not prohibited under this act. Specifies that a financial relationship or referral for designated health services is not prohibited under this act if the referral would not violate 42 U.S.C. section 1395nn if the designated health services were eligible for payment under medicare rather than the state's medicaid program. Clarifies that an entity that provides designated health services as a result of a prohibited referral is prohibited from billing the department of health care policy and financing for the service.

APPROVED by Governor April 7, 2005
EFFECTIVE April 7, 2005

H.B. 05-1025 Medicaid - presumptive eligibility - pregnant women. Allows a pregnant woman to be presumptively eligible for specified services under the state's medicaid program. Authorizes the department of health care policy and financing ("department") to designate additional medical assistance sites, as necessary, to accept medical assistance applications, to determine medical assistance eligibility, and to determine presumptive eligibility. Requires the department to notify the county in which the additional medical assistance site is located. Requires the department to develop training safeguards to prevent actions taken by staff of medical assistance sites from affecting food and cash assistance eligibility.

APPROVED by Governor April 22, 2005
EFFECTIVE April 22, 2005

H.B. 05-1037 Medical assistance - foster care children - adopted children. Clarifies that children for whom adoption assistance or foster care maintenance payments are made under title IV-E of the "Social Security Act", as amended, are mandated under federal law to receive medical assistance under the state's medicaid program.

Adds children for whom adoption assistance payments are made by the state, but who do not qualify for title IV-E assistance under the "Social Security Act", as amended, to the groups that Colorado has selected as optional groups to receive medical assistance under the state's medicaid program.

APPROVED by Governor March 31, 2005
EFFECTIVE March 31, 2005

H.B. 05-1066 Medicaid - obesity treatment program - sunset - appropriation. Contingent upon the receipt of sufficient gifts, grants, or donations, requires the department of health care policy and financing ("department") to develop and implement an obesity treatment program ("program") for the purpose of treating a medicaid recipient ("recipient") who has a body mass index that is equal to or greater than 30 and who has a comorbidity related to the recipient's obesity. Requires the program to be designed to treat recipients through the use of behavioral modification, self-management training, and medication. Authorizes the department to contract on a contingency basis for the development and implementation of the program. Sunsets the program, effective July 1, 2010.

Appropriates $137,857 and 0.5 FTE to the department to implement the act and specifies that the department is expected to receive an additional $153,732 in federal funds for the implementation of the act.

APPROVED by Governor May 26, 2005
EFFECTIVE July 1, 2005

H.B. 05-1086 Medicaid - medical assistance - legal immigrants - recovery - appropriation. Effective January 1, 2005, reinstates medical assistance eligibility to specific groups of qualified legal immigrants and specifies that these legal immigrants qualify as an optional group to be served under the state's medicaid program. Upon the reinstatement of medical assistance eligibility, repeals the state nursing facility service program.

Specifies that, to the extent allowable under federal law, the department of health care policy and financing ("department") shall recover from a legal immigrant's sponsor all medical assistance paid on behalf of a sponsored legal immigrant who is enrolled in the medical assistance program.

Appropriates moneys from constitutionally required tobacco and cigarette taxes to the department for the implementation of the act.

Provides that the repeal of the state nursing facility service program shall not take effect until the department implements specified provisions of the act.

APPROVED by Governor February 2, 2005
EFFECTIVE January 1, 2005
NOTE: As of publication date of this digest, the revisor of statutes had not received notification from the executive director that the department had implemented the specified provisions necessary to repeal the nursing facility service program.

H.B. 05-1131 Pharmacists - redispensing medication - donation - liability - appropriation. Authorizes a pharmacist to redispense specified medication that is prescribed to a patient or resident of a licensed hospital, hospital unit, nursing care facility, hospice, or assisted living residence ("licensed facility") if the medication was originally dispensed to another patient or resident in a licensed facility and was unused. Authorizes a pharmacist to donate a returned medication to a nonprofit entity that has the legal authority to possess the medication. Specifies that the pharmacist may only redispense or donate specified medication that has remained in its proper packaging and has been stored properly. Provides for the same redispensing authority for a pharmacist participating in the state's medicaid program.

Specifies that nothing in the act shall be construed to create or abrogate any liability on behalf of a prescription drug manufacturer for the storage, donation, acceptance, or dispensing of an unused donated medication or to create any civil cause of action against a prescription drug manufacturer, in addition to that which is available under applicable law. Requires the state board of pharmacy and the medical services board to adopt rules to implement the act.

Reduces the state fiscal year 2005-06 appropriation to the department of health care policy and financing by $733,970. Specifies that $366,985 of this amount shall be from federal funds and $366,985 shall be from the general fund.

APPROVED by Governor June 3, 2005
EFFECTIVE August 8, 2005
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 05-1152 Prescription drugs - Colorado cares Rx - clearinghouse - 340B program - appropriation. Establishes the Colorado cares Rx ("program") in the department of health care policy and financing ("department") to allow an eligible person to purchase prescription drugs at a discounted rate. Defines the eligibility criteria for the program. Requires the department to contract with one or more entities to administer the program and allows the contracted entity to utilize a multistate drug purchasing agreement, negotiate prescription drug prices with prescription drug manufacturers, wholesalers, and retailers, or utilize any other method for receiving lower cost prescription drugs. Authorizes the contracted entity to charge an annual fee of $25. Specifies that the dispensing fees and drug reimbursement rates to pharmacies for prescription drugs under the program shall be no less than the medicaid reimbursement rate to pharmacies for dispensing medications to medicaid recipients.

Beginning January 1, 2006, creates the Colorado Rx clearinghouse ("clearinghouse") to provide access to medically necessary prescription drugs through patient assistance programs sponsored by pharmaceutical drug manufacturers, drug wholesalers, or retail pharmacies, and the program. Requires the department to contract with the university of Colorado health sciences center, which in turn shall contract with a nonprofit corporation for the development, administration, and implementation of the clearinghouse. Establishes the requirements of the administering entity in developing and administering the clearinghouse and in serving rural and underserved communities. Specifies that the clearinghouse shall also provide assistance to individuals in obtaining medicare prescription drug benefits for which the individual is eligible. Prohibits the clearinghouse from purchasing prescription drugs for individuals eligible for clearinghouse services. Authorizes the department to accept gifts, grants, and donations for the administration of the clearinghouse.

Requires the department of public health and environment, the department of health care policy and financing, the department of human services, and the department of corrections to maximize prescription drug discounts within the programs administered by the departments through the utilization of the federal 340B drug pricing program in order to receive the maximum state budget savings.

Authorizes and encourages a human services referral service provider to provide referral information regarding patient assistance programs that are sponsored by pharmaceutical drug manufacturers.

Requires the department to allow a covered entity under the federal 340B drug pricing program to use the entity's formulary in lieu of a preferred drug list established as part of a multistate prescription drug purchasing pool. Specifies department requirements for reimbursing pharmacies when operating under a preferred drug list.

Appropriates $250,000 from the Colorado Rx clearinghouse cash fund for the implementation of the clearinghouse. Contingent on House Bill 05-1264 becoming law, appropriates a total of $278,688 in general fund moneys for the implementation of the act.

Makes various sections of the bill contingently effective upon House Bill 05-1264 and Senate Bill 05-102 becoming law.

VETOED by Governor June 1, 2005

H.B. 05-1243 Medicaid - consumer-directed care service model - appropriation. Extends the option of receiving home- and community-based services ("HCBS") through the consumer-directed care service model to all medicaid recipients who are enrolled in an HCBS waiver for which the department of health care policy and financing ("department") has federal waiver authority. Specifies that an eligible person shall not be required to disenroll from the person's current HCBS waiver in order to receive services through the consumer-directed care service model.

Specifies that certain professional licensing requirements do not apply to a person who is directly employed by an individual participating in the consumer-directed care service model and who is acting within the scope and course of such employment. Specifies the restrictions that apply to this professional licensure exclusion and the circumstances under which the exclusion does not apply.

Allows a consumer of attendant support to have an authorized representative who has the judgment and ability to assist the consumer in acquiring and utilizing services under the consumer-directed attendant support program. Specifies requirements for a person designated as an authorized representative. Repeals the requirement that a person have received medicaid-funded attendant support for the past 12 months in order to be eligible for consumer-directed attendant support.

Makes various adjustments to the 2005 general appropriations act to the department for the implementation of the act.

APPROVED by Governor June 3, 2005
EFFECTIVE June 3, 2005

H.B. 05-1245 State administered health care benefits programs - applicant requirements - department reporting requirements. Requires an applicant for health care benefits administered by the department of health care policy and financing (state department), including, but not limited to, benefits provided pursuant to the "Colorado Medical Assistance Act" and the children's basic health plan, and a person requesting uncompensated care in a hospital to identify the employer or employers of the proposed beneficiary of the health care benefits or, if the beneficiary is not employed, the adult responsible for providing the beneficiary's support. Requires the state department to report annually to the general assembly regarding employers with 50 or more employees who are public health program beneficiaries. Requires the state department to make the report available to any person who requests such report.

Makes the act contingent upon the passage of and savings realized from House Bill 05-1243.

VETOED by Governor June 3, 2005

H.B. 05-1261 Tobacco tax - tobacco education, prevention, and cessation act - appropriation. Creates in the state treasury the tobacco tax cash fund ("cash fund"). Specifies that the cash fund shall consist of moneys collected from the cigarette and tobacco taxes imposed pursuant to section 21 of article X of the state constitution. Requires the general assembly to annually appropriate 3% of the moneys deposited into the cash fund for health-related purposes to provide revenue for the state's general fund and old age pension fund and for municipal and county governments to compensate proportionately for tax revenue reductions attributable to lower cigarette and tobacco sales resulting from the implementation of the tax imposed pursuant to section 21 of article X of the state constitution.

Establishes separate funds for the allocation of the moneys collected through the imposition of cigarette and tobacco taxes as required by the state constitution, as follows: 46% of the moneys to the health care expansion fund; 19% to the primary care fund; 16% to the tobacco education programs fund; 16% to the prevention, early detection, and treatment fund.

Makes the necessary statutory changes to implement the collection of the cigarette and tobacco taxes imposed pursuant to section 21 of article X of the state constitution, which apply to taxes levied and collected on and after January 1, 2005.

Repeals the use of tobacco settlement moneys to fund the "Tobacco Education, Prevention, and Cessation Act" ("Act"), allowing these tobacco settlement moneys to be transferred into the general fund at the end of fiscal year 2004-05.

Reduces the appropriation from the tobacco litigation settlement cash fund by $4,438,893 to fund the Act and increases the appropriation from the tobacco education programs fund to fund the Act by the same amount.

Makes the enactment of section 1 of the act contingent upon the passage of House Bill 05-1262.

APPROVED by Governor June 2, 2005
EFFECTIVE June 2, 2005
NOTE: House Bill 05-1262 was signed by the governor June 2, 2005.

H.B. 05-1325 Mental health managed care organizations - contract requirements - department duties. Requires contracts between the department of health care policy and financing ("department") and mental health services managed care organizations under the medical assistance program to comply with all federal requirements including:

● Ensuring that recipients with complex or multiple needs receive treatment from appropriate providers in collaboration with other service providers;

● Informing recipients of their right to appeal a denial, reduction, or termination of requested services; and

● Administering initial stabilization treatment and transferring the recipient for appropriate continued services.

For recipients of mental health care services from a managed care organization, requires the department to have a patient representative program that complies with all federal requirements.

APPROVED by Governor May 26, 2005
EFFECTIVE August 8, 2005
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.