Health Care Policy And Financing - Digest of Bills

Digest of Bills - 2006

HEALTH CARE POLICY AND FINANCING

S.B. 06-1 Prescription drugs - medicaid - multi-state drug purchasing - Colorado cares Rx - appropriation. Requires the department of health care policy and financing ("department") to apply for federal authorization, as necessary, to enter into a multi-state 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 for-profit or nonprofit entities for purposes of the purchasing pool.

Requires the executive director of the department to promulgate any rules necessary for the state to receive the federal authorization necessary to implement the purchasing pool and for the state to generate the maximum amount of savings to the state medicaid program. Authorizes the department to purchase prescription drugs outside of the purchasing pool if the department determines the prescription drugs are medically necessary. Contains a reporting requirement.

Establishes the Colorado cares Rx program ("program") in the department to allow an eligible person, any political subdivision of the state, and any business to purchase prescription drugs at the discounted rate negotiated by the entity administering the program. Defines the eligibility criteria for the program. Requires the department's contract with one or more entities to implement and administer the program.

Appropriates $99,840 to the department for the implementation of this act. Specifies that $70,817 of this amount shall be from the general fund and $29,023 shall be from federal funds.

VETOED by Governor May 26, 2006

S.B. 06-44 Colorado indigent care program - primary care - adults - appropriation. Increases the minimum percentage of the federal poverty level of the Colorado indigent care program to 250% and specifies that the eligibility requirements shall be determined by rule of the medical services board.

Establishes the Colorado health care services fund ("fund"), and specifies how much in fiscal years 2005-06, 2007-08, and each of the 2 fiscal years thereafter the fund shall receive from the general fund exempt account. Specifies that 18% of the moneys annually appropriated from the fund shall be appropriated to Denver health and hospitals as the community health clinic provider for the city and county of Denver. Specifies how the remaining moneys annually appropriated will be allocated between community health clinics and primary care clinics operated by a licensed or certified health care facility to provide primary care services to low-income adults.

Makes various adjustments to the 2005 and 2006 general appropriations acts to fund the act.

APPROVED by Governor June 2, 2006
EFFECTIVE June 2, 2006

S.B. 06-128 Coordinate care for persons with a disability - pilot program - rules - reports - repeal. Directs a Colorado nonprofit organization with a board composed of persons interested in medicaid recipients with a disability to submit a proposed pilot program to the department of health care policy and financing ("department") on or before September 1, 2006. Directs the department to review the proposed pilot program and, by January 1, 2007, to:

● Report to the nonprofit organization and specified committees of the general assembly;

● Request, if it finds that the pilot program meets required components, request necessary federal authorizations to implement the pilot program.

Directs the department to implement the pilot program if it receives the necessary federal authorizations. Authorizes the medical services board to promulgate rules. If the pilot program is implemented, requires the department annually to report to the general assembly on the effects of the program. If the department can establish that the pilot program has resulted in cost savings and increased client satisfaction, authorizes the pilot program to be expanded into additional geographic areas of the state.

Establishes the coordinated care for people with disabilities fund ("fund"). Directs the state treasurer annually to transfer to the fund the interest earned from the breast and cervical cancer prevention and treatment fund.

Repeals the act on July 1 of the fifth year following implementation of the pilot program.

Makes various adjustments to the 2006 general appropriations act for the implementation of the act.

APPROVED by Governor May 25, 2006
EFFECTIVE May 25, 2006

S.B. 06-129 Medicaid - cash system of accounting - appropriation. Requires the department of health care policy and financing to use the cash system of accounting, regardless of the source of revenues involved, for all activities related to the financial administration of any non-administrative expenditure that qualifies for federal financial participation under title XIX of the federal "Social Security Act", except for expenditures made for the Colorado indigent care program.

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

APPROVED by Governor May 11, 2006
EFFECTIVE May 11, 2006

S.B. 06-131 Class I nursing facility reimbursement system - study - report - increase rate - appropriation. Directs the department of health care policy and financing ("department") to conduct a study and report to specified committees of the general assembly on a new reimbursement system for class I nursing facility providers based upon a pricing model system, a pay for performance system, and any other reimbursement system selected by the department.

Provides a floor for the reimbursement rate that class I nursing facility providers shall receive and a ceiling on the increase that a class I nursing facility provider may receive.

For the 2006-07 fiscal year, repeals an 8% cap on any increase in health services costs for a class I nursing facility with an average Medicaid census of over 64% of the actual residents.

Increases the general fund appropriation to the department in the 2006 general appropriations act by $1,188,203.

APPROVED by Governor June 2, 2006
EFFECTIVE June 2, 2006

S.B. 06-135 Children's basic health plan - pregnant women - appropriation. Specifies that until the department of health care policy and financing ("department") receives federal approval to increase eligibility in the children's basic health plan ("plan") for a pregnant woman whose family income exceeds 185% but does not exceed 200% of the federal poverty level, a pregnant woman within this income range shall be considered enrolled in the plan throughout the woman's pregnancy and for 60 days following the pregnancy. For fiscal year 2005-06, authorizes the department to use tobacco tax moneys appropriated from the health care expansion fund to pay for 100% of the expenses related to the pregnant woman's enrollment in the plan until federal financial participation is available.

Appropriates $353,161 from the health care expansion fund to the department for fiscal year 2005-06.

APPROVED by Governor May 25, 2006
EFFECTIVE May 25, 2006

S.B. 06-145 Local government - fee authority - reimbursement - unreimbursed medicaid costs. Authorizes a local government to charge a fee on the gross or net revenue of certain medical providers located within its territorial boundaries for the purposes of obtaining federal financial participation under the state's medicaid program to reimburse providers for unreimbursed medicaid costs. Subject to federal medicaid regulations, authorizes a local government, in any given year, to elect to not assess the fee imposed on certain medical providers and not make the reimbursements to the providers for that year. Requires the local government to certify to the department of health care policy and financing ("department") the amount paid to qualified providers for unreimbursed medicaid costs, which shall include the distribution of the fee collected. Requires the local government to pay qualified providers within the local government's territorial boundaries consistent with the department's calculation of the unreimbursed medicaid costs for the qualified providers within that territorial boundary.

Requires the department to amend the state medicaid plan, effective July 1, 2006, for the purpose of paying for unreimbursed medicaid costs incurred by qualified providers. Requires the medical services board to define unreimbursed medicaid costs by rule. Requires the department to distribute to a local government that has certified payment to qualified providers the federal financial participation received for eligible unreimbursed medicaid costs of the qualified providers within the local government's territorial boundaries.

APPROVED by Governor May 5, 2006
EFFECTIVE May 5, 2006

S.B. 06-219 Department of health care policy and financing - administrative reorganization - appropriation. Reorganizes and amends statutes relating to all programs administered by the department of health care policy and financing ("department"), including, but not limited to:

● The Colorado medical assistance act;

● The Colorado indigent care program;

● The children's basic health plan;

● The old age pension health and medical care program; and

● The comprehensive primary and preventive care grant program.

Consolidates all statutes relating to the department in title 25.5, Colorado Revised Statutes. Duplicates in title 25.5, Colorado Revised Statutes, existing county administrative and financial provisions that are currently in the human services code and that relate to the programs the department administers.

Repeals the July 1, 2007, repeal date of the medical services board. Transfers the administration of the home care allowance and adult foster care from the department to the department of human services. Repeals obsolete provisions.

Appropriates $18,306,628 to the department for county administration. Appropriates $1,593,624 to the department for administrative case management payments to counties. Makes various adjustments to the 2006 general appropriations act for appropriations to the department and the department of human services.

APPROVED by Governor June 6, 2006
EFFECTIVE July 1, 2006

S.B. 06-227 Programs administered by the state department - public health program applicants - required identification of employers - reporting requirements of state department, department of labor and employment, and employers - penalty - fund - appropriation. 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.

Requires employers who employ 500 or more employees who are public health program beneficiaries or whose dependents are public health program beneficiaries in this state to submit information to the executive director (director) of the department of labor and employment regarding the number of part-time and full-time employees and the amount spent on health care for the employees. Requires the director to submit a report annually to the governor and the general assembly that compiles the information reported to the director from each employer.

Creates a penalty for employers who fail to timely submit the required information. Creates the Colorado fair share health care cash fund, and requires the penalty amounts to be appropriated to the fund. Requires that moneys in the fund be annually appropriated to the state department for the purposes of the "Colorado Medical Assistance Act".

Adjusts appropriations made in the 2006-07 general appropriations act.

VETOED by Governor June 2, 2006

H.B. 06-1079 Medicaid providers - penalties - informal hearing. Specifies that a medical provider who knowingly receives payment or seeks collection through a third party from a recipient or the estate of a recipient to which the provider is not lawfully entitled is liable to the recipient or the estate of the recipient. Specifies the amount for which the medical provider is liable. Provides that a party may send notice of claim to the provider and to the department of health care policy and financing ("department"), and requires the executive director of the department to promulgate rules for an informal hearing process. Excludes licensed long-term care facilities.

APPROVED by Governor March 27, 2006
EFFECTIVE January 1, 2007
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 06-1211 Retaliation - definition. Defines "retaliation" for purposes of any rule or action taken by the department of health care policy and financing.

APPROVED by Governor May 25, 2006
EFFECTIVE May 25, 2006

H.B. 06-1270 Eligibility determinations - at school sites - demonstration program - advisory committee - repeal - appropriation. Establishes a demonstration project to authorize qualified personnel to make determinations of eligibility for medicaid and the children's basic health plan at school sites. For the 2007-08 school year, directs the executive director ("executive director") of the department of health care policy and financing ("department") to select school districts to participate in the demonstration project. Establishes an advisory committee to make recommendations to the executive director on the demonstration project. Directs the medical services board to promulgate rules governing the demonstration project. Subject to the receipt of gifts, grants, or donations, directs the department to contract for an independent evaluation on the project to be provided to committees of the general assembly. Repeals the demonstration project effective July 1, 2010.

Increases the general fund appropriation to the department in the 2006 general appropriations act by $29,766.

APPROVED by Governor June 2, 2006
EFFECTIVE June 2, 2006

H.B. 06-1299 Providers - durable medical equipment - disposable medical supplies - rules - requirements. After January 1, 2007, requires the rules of the medical services board to prohibit payment to providers of durable medical equipment and disposable medical supplies under the fee-for-service and primary care physician programs of the medical assistance program unless the provider complies with specified requirements or contracts with a provider that complies with the requirements.

APPROVED by Governor April 18, 2006
EFFECTIVE August 7, 2006
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.