Health Care Policy And Financing - Digest of Bills

Digest of Bills - 2007

HEALTH CARE POLICY AND FINANCING

S.B. 07-1 Colorado Cares RX Program - rules - cash fund - repeal - appropriation. Establishes in the department of health care policy and financing ("department") the Colorado Cares Rx program to provide generic and non-patented prescription drugs to eligible persons at discounted prices. Specifies eligibility requirements. Directs the medical services board to adopt rules. Directs the executive director of the department to appoint an advisory council to advise the department and the medical services board regarding rules to implement the program. Requires a participating pharmacy to provide a 30-day supply of generic and nonpatented prescription drugs to an eligible person at the lesser of:

● An amount negotiated by the department and the generic or nonpatented drug manufacturer that is between the average manufacturer's price and the wholesale acquisition cost, plus a dispensing fee; or

● The customary charge for the drug at the pharmacy.

Clarifies that making a false statement in an application constitutes 2nd degree perjury.

Establishes the Colorado Cares Rx Cash Fund ("cash fund") to receive registration fees from eligible persons. Requires, after the payment of necessary expenses, the general fund appropriation to be repaid from the cash fund.

Repeals the program, effective June 30, 2013, and directs that the program be reviewed prior to the repeal.

For the fiscal year commencing July 1, 2006, appropriates from the general fund $145,927 to the department, and, for the fiscal year commencing July 1, 2007, appropriates from the cash fund $2,253,953 and 2.5 FTE to the department.

APPROVED by Governor February 5, 2007
EFFECTIVE February 5, 2007

S.B. 07-2 Medicaid - foster care - emancipated minors - appropriations. Allows persons younger than 21 years of age who were in the foster care system and who attained the age of 18 years or who otherwise became emancipated to continue to be eligible for medicaid. Provides funding for extending medicaid eligibility to this population from the health care expansion fund.

Makes the following appropriations:

● $34,650 to the department of health care policy and financing, for allocation to the executive director's office, $8,663 of which is from the health care expansion fund and $25,987 is from federal funds.

● $8,550 to the department of human services, for allocation to the office of information technology services, $4,275 of which is from the health care expansion fund and $4,275 is from federal funds.

● $3,900,859 to the department of health care policy and financing, for allocation to the medical services premiums division, $1,950,430 of which is from the health care expansion fund and $1,950,429 is from federal funds.

● $4,380,871 to the department of health care policy and financing, for allocation to the medicaid mental health community programs division, for mental health capitation payments for medicaid eligible clients, $2,190,435 of which is from the health care expansion fund and $2,190,436 is from federal funds.

APPROVED by Governor May 15, 2007
EFFECTIVE May 15, 2007

S.B. 07-37 Organ and tissue donation awareness fund - name change - Emily Maureen Ellen Keyes organ and tissue donation awareness fund - income tax - voluntary contribution. Continues the organ and tissue donation awareness fund until July 1, 2018. Changes the name of the fund to the Emily Maureen Ellen Keyes organ and tissue donation awareness fund. Extends the period that state income tax return forms shall include a line whereby individual taxpayers may make a voluntary contribution to the fund.

APPROVED by Governor March 30, 2007
EFFECTIVE March 30, 2007

S.B. 07-130 Medical assistance programs - primary care - medical home for children - appropriation. Defines the term "medical home" as an appropriately qualified medical specialty, developmental, therapeutic, or mental health care practice that verifiably ensures continuous, accessible, and comprehensive access to and coordination of community-based medical care, mental health care, oral health care, and related services for a child.

Instructs the state department of health care policy and financing ("department") to develop systems and standards to maximize the number of children who are enrolled in the medical assistance program or the children's basic health plan who have a medical home. Requires the department to report annually to specified committees of the general assembly its progress toward maximizing the number of children enrolled in the medical assistance program or the children's basic health plan who have a medical home.

Appropriates $44,965 and 1.0 FTE from the general fund to the department for allocation to the executive director's office for the implementation of the act.

Makes the act contingent on the passage of House Bill 07-1021 and the cost savings realized by said act.

APPROVED by Governor May 31, 2007
EFFECTIVE May 31, 2007
NOTE: House Bill 07-1021 was signed by the governor May 31, 2007. As of publications date, the revisor of statutes had not received notification from the staff director of the joint budget committee regarding cost savings realized by said act.

S.B. 07-133 Cash system of accounting - appropriations. Requires the department of health care policy and financing to use the cash system of accounting for the following:

● Old age pension health and medical care funds;

● "Clawback" provisions of the federal Medicare drug plan; and

● The children's basic health plan.

For the 2007-08 fiscal year, reduces appropriations by the following amounts:

● $4,088,243 to the indigent care program division;

● $680,779 to the old age pension state medical program; and

● $7,173,368 for the Medicare modernization act of 2003.

APPROVED by Governor April 11, 2007
EFFECTIVE July 1, 2007

S.B. 07-186 Children's basic health plan - creditable insurance. Specifies that the children's basic health plan ("CHP+") constitutes creditable insurance for purposes of preexisting condition limitations. Establishes that disenrollment from CHP+ constitutes a condition permitting late enrollment in an employer's health plan. Requires a policyholder to give a carrier notice at least 30 days prior to termination of coverage for a dependent if the dependent becomes enrolled in CHP+.

APPROVED by Governor April 11, 2007
EFFECTIVE July 1, 2007

S.B. 07-211 Health care for children - advisory committee - chief medical officer - presumptive eligibility - lawful presence - access and quality of care - clinical standards - appropriation. Establishes an advisory committee in the department of health care policy and financing ("department") to develop and oversee the implementation of a plan to provide health coverage for all low-income children in Colorado by the end of 2010. Specifies duties of the advisory committee. Requires the advisory committee to submit, at least annually, reports and recommendations to specified committees of the general assembly.

Authorizes the executive director of the department to appoint a chief medical officer. Specifies qualifications and duties of the chief medical officer.

Establishes presumptive eligibility for medicaid for children under 18 years of age whose parent or guardian's declaration establishes financial eligibility.

For the baby and kid care program under medicaid:

● Establishes presumptive eligibility for children who meet the income level requirements; and

● Provides for 12-month enrollment following eligibility except for defined circumstances and ensures continuous enrollment, if eligible, for the children's basic health plan.

For the children's basic health plan:

● Establishes presumptive eligibility for children who meet the income level requirements; and

● Ensures continuous enrollment between the children's basic health plan and medicaid, if eligible for medicaid.

Excludes from the requirement to prove lawful presence pregnant women and individuals over 18 and under 19 years of age who remain eligible for medical benefits after their 18th birthday.

Directs the department to report to specified committees of the general assembly on measures of access and quality of care received by children eligible for benefits through the department.

Directs the department to develop clinical standards and methods for collecting, analyzing, and disclosing information concerning clinical performance. Directs the department to review the data generated and make recommendations concerning strategies to improve health outcomes.

Makes the effectiveness of certain provisions of this act contingent upon House Bill 07-1021 becoming law and upon said bill having a net general fund savings equal to or greater than the general fund fiscal estimate for this act.

Makes various adjustments to the 2007 general appropriations act for the implementation of this act.

APPROVED by Governor May 31, 2007
PORTIONS EFFECTIVE July 1, 2007
PORTIONS EFFECTIVE January 1, 2008
NOTE: House Bill 07-1021 was signed by the governor May 31, 2007. As of publications date, the revisor of statutes had not received notification from the staff director of the joint budget committee regarding cost savings realized by said act.

H.B. 07-1021 Prescription drug information and technical assistance program - creation - rules. Creates the prescription drug information and technical assistance program to provide prescription drug assistance for recipients of prescription drug benefits pursuant to the "Colorado Medical Assistance Act". Grants rule-making authority to the department of health care policy and financing to establish and administer the program. Requires the department to design a calculation for savings under the program.

Adjusts appropriations made to the annual general fund appropriation act to the department of health care policy and financing by increasing the appropriation to the executive director's office by $35,524 and 1.0 FTE and by decreasing the appropriation for the medical services premium divisions by $624,803.

APPROVED by Governor May 31, 2007
EFFECTIVE July 1, 2007

H.B. 07-1183 Medicaid - class I nursing facilities - feasability study - reimbursement rates - grant program - repeal - appropriation. Extends the feasibility study of a new reimbursement system for class I nursing facilities for an additional year.

Effective July 1, 2007, establishes a grant program that increases an eligible facility's reimbursement rate if that facility's overall reimbursement rate for the fiscal year commencing July 1, 2006, was increased due to statutory provisions, but whose overall reimbursement rate for the fiscal year commencing July 1, 2007, will be less than the overall reimbursement rate as of July 1, 2006.

Repeals the grant program effective July 1, 2008.

For the 2007-08 fiscal year, appropriates $198,500 from the general fund to the department of health care policy and financing for the implementation of the grant program.

Makes certain provisions contingent on the passage of and cost-savings realized by House Bill 07-1021.

APPROVED by Governor June 1, 2007
PORTIONS EFFECTIVE June 1, 2007
PORTIONS EFFECTIVE July 1, 2007
NOTE: House Bill 07-1021 was signed by the governor May 31, 2007. As of publication date, the revisor of statutes had not received communication from the staff director of the joint budget committee regarding the cost-savings realized in House Bill 07-1021.

H.B. 07-1216 Medicaid - application sites - medicaid-eligible days - appropriation. Effective January 1, 2008, adds the university of Colorado hospital and the Aurora medical center as sites eligible to accept medicaid applications and determine eligibility. Requires the department of health care policy and financing ("department") to reimburse medical assistance and out-stationing sites for processing a medical assistance application at not less than the average cost for a state employee to process an application for medical assistance.

Directs the department to provide hospitals with information on the number of medicaid-eligible days for prior years.

For the 2007-08 fiscal year, appropriates $3,280 to the department for the implementation of this act.

VETOED by Governor June 1, 2007

H.B. 07-1258 Medically indigent program - Colorado health care services fund. Removes the restriction that the moneys in the Colorado health care services fund for the medically indigent program ("CICP") be used for low-income adults, thereby allowing the funds to be used for all CICP enrollees, including children. Requires the department of health care policy and financing to maximize all available federal matching moneys for community health clinics to the extent allowed under federal law.

APPROVED by Governor April 16, 2007
EFFECTIVE April 16, 2007

H.B. 07-1319 Medicaid - reviews and audits - informal reconsideration - reports. Sets forth notice requirements and specification of important dates for a review or audit of a medicaid provider. Limits document request from a reviewer or auditor to records directly related to claims for reimbursement. Requires, upon the request of the provider, a reviewer or auditor to conduct an interview with the provider prior to the preparation of a preliminary draft of the report.

Requires the department of health care policy and financing ("state department") to notify a provider of and allow a provider to request an informal reconsideration. Establishes time lines and notification requirements for informal reconsiderations.

Encourages the state department to meet with organizations or associations of providers prior to the start of an audit cycle and to prepare an annual report on common findings. Directs the state department to submit reports on contingency-based contracts for reviews or audits to the health and human services committees of the general assembly.

Requires review or audit procedures to be adopted by rule of the medical services board and be referenced in any contract with a provider.

APPROVED by Governor May 30, 2007
EFFECTIVE May 30, 2007

H.B. 07-1346 Colorado medical assistance act - statewide managed care system - appropriation. Authorizes the department of health care policy and financing ("department") to enter into prepaid inpatient health plan agreements ("PIHP agreement") to provide for the payment of services for recipients under the medical assistance program. Specifies that PIHP agreements may provide for an incentive payment if the contractor substantially exceeds predetermined quality indicators. Requires the contractor to pay at least 75% of the incentive payment to medicaid providers. Authorizes an increase in the fees paid under a PIHP agreement to cover the costs of electronic medical records.

Requires an applicant for the pilot program for coordinated care for people with a disability ("program") to submit a proposed plan of financial operation to the insurance commissioner ("commissioner"). Authorizes the commissioner to promulgate rules necessary to amend the plan after notice and a public hearing. Requires an applicant for the program to submit annually an audited financial report for the program for the preceding calendar year to the commissioner. Requires the commissioner or the commissioner's designee to conduct an examination of the financial status of the program at least once every 5 years.

Repeals the requirement that a capitation payment to a managed care organization under the medical assistance act may not exceed 95% of the costs of a similar population under fee-for-service costs.

Requires a health maintenance organization whose sole business is providing health care services to recipients under the "Colorado Medical Assistance Act", the children's basic health plan, or medicare to maintain a minimum surplus of not less than $4,000,000 dollars and to maintain a minimum claims liability within its financial statement.

For the 2007-08 fiscal year, appropriates to the department the lesser of $37,500 or 3.8% of the amount allocated to the short-term innovative health program grant fund for studying the use of prepaid inpatient health plan agreements.

APPROVED by Governor May 29, 2007
EFFECTIVE May 29, 2007

H.B. 07-1370 Medicaid - long-term care - coordinated care pilot program. Specifies that the coordinated care pilot program for long-term care services ("pilot program") shall include a comparison of populations from various communities. Extends the repeal of the pilot program to July 1, 2012.

APPROVED by Governor June 1, 2007
EFFECTIVE June 1, 2007

H.B. 07-1374 Medicaid - long-term care - transitioning - working group. Directs the executive director ("executive director") of the department of health care policy and financing ("state department") to appoint a working group to study the process of transitioning clients to a long-term care setting. Requires the working group to report to the executive director by December 1, 2007. Requires the report to include a list of federal funding opportunities and a timeline and estimated associated costs for the completion of changes to the system of long-term care. Authorizes the working group to submit additional reports to the executive director. Authorizes the state department to seek federal authorization to implement changes recommended by the working group.

APPROVED by Governor May 30, 2007
EFFECTIVE May 30, 2007