Health Care Policy And Financing - Digest of Bills

Digest of Bills - 2008

HEALTH CARE POLICY AND FINANCING

S.B. 08-3 Medicaid - family planning pilot - waiver. Directs that the percentage of the federal poverty level used to determine eligibility for the family planning pilot program be established in the request for a federal waiver. Specifies that the waiver shall not seek authority to disregard specified federal law.

APPROVED by Governor March 13, 2008
EFFECTIVE March 13, 2008

S.B. 08-6 Medicaid - suspension of benefits for confined persons - appropriation. Unless federal financial participation is available, suspends medicaid benefits for persons who are:

● Confined to a correctional institution or in a jail;

● Committed to a juvenile commitment facility; or

● Committed to or placed in a department of human services facility pursuant to court order or certification.

Increases the general fund appropriation to the office of the executive director of the department of health care policy and financing, for information technology contracts, by $74,624 for implementation of the act. Anticipates that the department of health care policy and financing will receive an additional $223,871 in federal funds.

Increases the appropriation to the department of human services, office of information technology services - medicaid funding by $44,079 for implementation of the act. Anticipates the department of human services will receive an additional $44,384 in federal funds.

Increases the appropriation to the department of human services, for the Colorado benefits management system, by $150,392 for implementation of the act. Anticipates the department of human services will receive an additional $112,688 in federal funds.

APPROVED by Governor May 20, 2008
EFFECTIVE May 20, 2008

S.B. 08-22 Children's basic health plan - overexpenditure authority. Upon approval of the governor, authorizes expenditures of the department of health care policy and financing ("department") for the children's basic health plan ("plan") to exceed the amount appropriated. Limits an overexpenditure from the general fund for said purpose to $250,000 in any fiscal year.

Deletes language requiring the general assembly to establish enrollment caps for the plan. Deletes language directing the department in years in which plan enrollment is limited, to prioritize children who would be eligible for medicaid as if there were no asset testing.

APPROVED by Governor April 14, 2008
EFFECTIVE April 14, 2008

S.B. 08-68 Medicaid - mental health - telemedicine. Allows the use of telemedicine for mental health care services under medicaid.

APPROVED by Governor March 19, 2008
EFFECTIVE August 5, 2008
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

S.B. 08-90 Medicaid - mail-order prescription drugs - appropriation. Expands the use of mail-order prescription drugs to recipients who have third-party insurance that requires the recipient to obtain maintenance medications through mail order. Prohibits a mail-order pharmacy from charging the recipient more than the medicaid copayment. Authorizes a mail-order pharmacy to bill the medicaid program for the difference between the medicaid copayment and the third-party insurer's copayment or deductible.

Reduces the general fund appropriation to the department of health care policy and financing for medical services premiums by $279,272.

APPROVED by Governor May 20, 2008
EFFECTIVE May 20, 2008

S.B. 08-99 Medicaid - foster children - eligibility after eighteen years of age - appropriation. Allows a person for whom the state made foster care maintenance payments but who did not meet certain federal requirements and who attained 18 years of age or otherwise became emancipated to continue to be eligible for medicaid until reaching 21 years of age. Requires a court or guardian ad litum, before closing a youth's child welfare case prior to the youth's 18th birthday, to notify the youth that he or she will lose the right to receive medicaid until the youth's 21st birthday.

Appropriates $346,061 from the health care expansion fund to the department of health care policy and financing ("department") for medical services premiums. Anticipates that the department will receive an additional $346,060 in federal moneys for this purpose.

Appropriates $368,339 from the health care expansion fun to the department for mental health capitation payments for medicaid-eligible clients. Anticipates the department will receive an additional $368,340 in federal moneys for this purpose.

APPROVED by Governor May 28, 2008
EFFECTIVE July 1, 2008

S.B. 08-118 Medicaid - disease management programs - transfers - appropriation. For fiscal years 2008-09 through 2012-13, annually transfers $2 million from the prevention, early detection, and treatment fund to the department of health care policy and financing ("department") for medicaid disease management programs ("programs"). In developing and implementing the programs, directs the department to consult with the department of public health and environment.

Appropriates $2,000,000 to the department from the amount transferred for implementation of the act. Anticipates the department will receive an additional $2,000,000 in federal funds for implementation of the act.

APPROVED by Governor May 14, 2008
EFFECTIVE May 14, 2008

S.B. 08-148 Medicaid - managed care system - definitions. Defines a "managed care entity" for the statewide managed care system under the "Colorado Medical Assistance Act" to mean an entity that contracts to provide services in a managed care system, including managed care organizations, prepaid inpatient health plans, and prepaid ambulatory health plans, but excluding primary care case managers.

APPROVED by Governor April 10, 2008
EFFECTIVE August 5, 2008
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

S.B. 08-160 Children's basic health plan - eligibility - mental health services. For the children's basic health plan:

● Effective March 1, 2009, increases the percentage of the federal poverty level for eligibility for persons at least 6 and under 19 years of age to 225%, and authorizes the department of health care policy and financing ("department") to increase the percentage level to 250% subject to available appropriations;

● Effective October 1, 2009, increases the percentage of the federal poverty level for eligibility for pregnant women to 225%, and authorizes the department to increase the percentage to 250% subject to available appropriations;

● Effective January 1, 2009, directs the medical services board to include in the schedule of services mental health services that are at least as comprehensive as those provided to medicaid recipients; and

● Authorizes certain moneys in the children's basic health plan trust ("trust") to be used to pay the state's portion of computer changes necessary to expand eligibility under the plan.

Appropriates from the trust to the department $64,386 for information technology contracts and projects; $350 for children's basic health plan administration; $1,577,258 for children's basic health plan premium costs; $98,845 for children's basic health plan dental costs; and $16,835 for information technology services. Also appropriates to the department $30,328 from enrollment fees for children's basic health plan premium costs and $21,776 from the trust to the department of human services for the Colorado benefits management system.

APPROVED by Governor June 3, 2008
PORTIONS EFFECTIVE June 3, 2008
PORTIONS EFFECTIVE January 1, 2009
PORTIONS EFFECTIVE March 1, 2009
PORTIONS EFFECTIVE October 1, 2009

S.B. 08-161 Medicaid - children's basic health plan - income eligibility verification - appropriation. Subject to the receipt of sufficient gifts, grants, or donations to cover the costs and to the extent authorized by federal law, provides that the department of health care policy and financing ("department") shall adopt rules to:

● Allow the department to verify income eligibility under medicaid and the children's basic health plan through the records of the division of employment and training in the department of labor and employment ("division") or through the income, eligibility, and verification system ("verification system");

● Allow applicants to submit income information more current than the records of the division or the verification system;

● Reenroll recipients of medicaid and the children's basic health plan if the records of the division or the verification system establish the recipient's income eligibility;

● Provide that the department shall not pursue recovery from a county department if it is determined that a recipient was not eligible for benefits solely based upon the recipient's income after the recipient had been determined eligible based upon the records of the division or the verification system; and

● Exclude from the provision that the department verify income eligibility through the records of the division or the verification system recipients who have self-employment income.

Directs the advisory committee on covering all children in Colorado to investigate the feasibility of combining medicaid and the children's basic health plan.

Appropriates $10,541 to the department of health care policy and financing, executive director's office, general administration, for operating expenses; appropriates $2,933 to the department of health care policy and financing, department of human services Medicaid-funded programs, office of information technology services - Medicaid funding, for the Colorado benefits management system; and appropriates $9,345 to the department of human services, for the Colorado benefits management system for the implementation of this act. Anticipates the department and the department of human services will receive additional amounts in federal funds.

APPROVED by Governor June 3, 2008
EFFECTIVE June 3, 2008

S.B. 08-214 Medicaid - hospitals and home health care agencies - local provider fees. Subject to receipt of federal authorizations, authorizes certain local governments to charge a provider fee to and collect a provider fee from hospitals and home health care agencies within the local government's territorial jurisdiction. Authorizes the department of health care policy and financing ("department") to distribute directly to qualified providers the federal financial participation received for local governments that make certified payments to hospitals or home health care agencies ("qualified providers").

Authorizes a local government that imposes a fee on qualified providers within the local government's jurisdiction to either pay the fee to the department itself or direct the qualified provider to pay the fee to the department. Requires the department to distribute, less its administrative costs, the fee and any matching federal financial participation received to the qualified providers. Establishes a cash fund for the moneys received by the department. Authorizes an appropriation from the cash fund to pay the department's administrative costs associated with the fee.

APPROVED by Governor May 20, 2008
EFFECTIVE May 20, 2008

S.B. 08-217 Centennial care choices program - request for information - value benefit plans - report to legislative committees - future legislation - request for proposals - dedicated funding source - appropriation. Authorizes the creation of the centennial care choices program (program) to reduce the state's uninsured population and improve access to affordable health care. Prior to enactment of the program, requires the state department of health care policy and financing (state department), in coordination with the division of insurance (division) in the department of regulatory agencies and a panel of expert advisors (panel), to issue a request for information (RFI) to health insurance carriers and other interested parties, including the state, regarding the development of the program and requesting specific information regarding the design of and benefits included in a value benefit plan (VBP) to be offered in the individual market with a specified benchmark standard and the percentage differential in rates for VBPs depending on whether an individual mandate to purchase health insurance is or is not imposed by the state. Precludes the state department from specifying in the RFI the benefit design or other details to be included in a proposed VBP. Requires the state department, division, and panel, in developing the RFI, to consider the potential risks of adverse selection, crowd out, and other factors that may destabilize the small group and individual insurance markets resulting from the availability of VBPs in the individual market.

Specifies certain assumptions that interested parties are to make in responding to the RFI, including the following:

● An assumption that a VBP will, at a minimum, include benefits for primary and preventive care and participation in wellness programs; provide the lowest level of benefits available in the individual market; encourage the use of health information technology and telemedicine; encourage the use of pay-for-performance for health care providers, as appropriate; provide consumers with educational materials regarding access to internet-based health care tools; specify an adequate network of providers; encourage the use of regional networks of providers; include optional coverage choices for purchase by consumers; limit demographic rating characteristics to age and geography and specify premium levels for each VBP based on age group, region by region; be offered statewide and issued to eligible Colorado residents; and allow for payment of all or a portion of the premium from a state-paid subsidy;

● An assumption that the state may impose a requirement that all Coloradans obtain creditable health care coverage and, if so, that the state will establish an enforcement mechanism;

● An assumption that a VBP will be the minimum benefits package available in the individual market;

● An assumption that the state will create a sliding scale premium subsidy program to assist low-income residents in paying health insurance premiums;

● An assumption that the state will amend the state plan to expand eligibility for participation in medical assistance programs under the "Colorado Medical Assistance Act" to adults whose family income does not exceed 100% of the federal poverty level; and

● An assumption that the state will create a dedicated source of revenue, if necessary, to fund the program.

Requires the state department, division, and panel to submit a progress report to the health and human services committees of the senate and house of representatives (legislative committees) by December 15, 2008, and to submit a final report to the legislative committees by March 1, 2009, detailing the results of the RFI process and actuarial and cost savings research conducted by the state department, division, and panel, and containing a detailed summary of the information submitted by parties responding to the RFI. Requires the final report to also include information regarding any legislation that would be required if the general assembly chooses to proceed to implement the program and cost projections regarding funding necessary to implement the program.

Requires the legislative committees to meet jointly to consider the final report and to determine whether to proceed with the program and recommend legislation necessary to implement the program and create a funding source. If legislation is recommended, specifies inclusion of the following elements in the legislation:

● Standards for VBPs to satisfy in order to be offered in the individual market;

● A process for periodic review of VBPs;

● Creation of a consumer advisory council for the program;

● A mechanism to encourage the use of evidence-based medicine;

● Authority to create health marts to assist individuals in selecting the VBP that best meets his or her needs; and

● A ballot question to seek voter approval for a new or increased tax or tax rate, if that is the mechanism chosen to fund the program.

If the general assembly enacts legislation creating the program and has identified a funding source for the program, authorizes the state department, division, and panel to develop and issue a request for proposals (RFP) to interested parties to submit proposals for plan designs for VBPs to be offered in the individual market based on the parameters specified in the RFI and implementing legislation. Prior to issuing the RFP, requires the state department, division, and panel to develop a benchmark price or affordability standard for VBPs to ensure that eligible individuals are able to purchase a VBP.

Allows interested parties that do not yet hold a certificate of authority to engage in the insurance business in this state to participate in the RFI and RFP processes, but requires such parties to obtain a certificate of authority from the insurance commissioner prior to offering a VBP in this state. If the general assembly modifies the design of VBPs after an interested party has submitted a response to the RFI or RFP, exempts the party from any further participation requirements.

Clarifies that the act does not impose a mandate that individuals in the state purchase health insurance and does not limit the ability of the general assembly to enact health care reforms that do not include such a requirement.

Appropriates $128,700 from the general fund and $62,500 from gifts, grants, and donations to the department of health care policy and financing for the implementation of the act. Appropriates $29,500 from the division of insurance cash fund to the division of insurance in the department of regulatory agencies for the implementation of the act.

APPROVED by Governor June 3, 2008
EFFECTIVE June 3, 2008

S.B. 08-230 Medicaid - unit of government hospital care providers - taxing authority - state university teaching hospital - appropriation. Authorizes specified governmental hospital care providers, subject to voter approval, to levy and collect a sales tax within certain geographic areas.

Establishes a definition of "state university teaching hospital". Authorizes the general assembly to appropriate moneys annually to state university teaching hospitals for services provided under the state's medicaid program.

For the 2007-08 fiscal year, appropriates from the general fund to the department of health care policy and financing ("department") $410,000 for Denver health and hospital authority and $95,251 for university of Colorado hospital authority and reduces appropriations to other medicaid programs by the same amounts. For the 2008-09 fiscal year, appropriates from the general fund to the department $914,504 for the Denver health and hospital authority and $348,919 for university of Colorado hospital authority, and reduces appropriations to other medicaid programs by the same amounts.

APPROVED by Governor May 22, 2008
EFFECTIVE May 22, 2008

H.B. 08-1032 Medicaid - generic drugs - state maximum allowable cost program. Authorizes the department of health care policy and financing ("department") to use a state maximum allowable cost program ("S-MAC") to adjust the amount paid to pharmacies for prescription drugs. For prescription drugs that are subject to the federal upper payment limit as established in the federal "Deficit Reduction Act of 2005", to the extent possible, directs the department to maximize the federal financial participation paid to local pharmacies for prescription services. If the department changes the method used to establish prices under S-MAC, requires the department to notify the joint budget committee of any anticipated fiscal impacts.

VETOED by Governor June 2, 2008

H.B. 08-1062 Prescription drug information and technical assistance program - expansion. Allows the department of health care policy and financing to expand the prescription drug information and technical assistance program to include all programs administered by the department.

APPROVED by Governor March 31, 2008
EFFECTIVE August 5, 2008
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 08-1063 Medicaid - community mental health services - capitated rates. Specifies that a managed care organization that provides community mental health services to recipients of medicaid is not subject to the usual rate calculation requirements for medicaid managed health care organizations, including the 100% fee-for-service upper payment limitation, but that a proposal from such a managed care organization must be certified as actuarially sound. Directs the department of health care policy and financing to establish cost-effective capitated rates for community mental health services that include cost containment mechanisms.

APPROVED by Governor April 3, 2008
EFFECTIVE April 3, 2008

H.B. 08-1072 Medicaid - developmental disability buy-in program - appropriation. Directs the department of health care policy and financing ("department") to obtain and submit to the joint budget committee an actuarial study of a program to expand eligibility under medicaid through a medicaid buy-in program ("program") for individuals with disabilities who would otherwise be eligible for supplemental security income except for their income and for individuals with disabilities whose medical condition improves. If approved by the joint budget committee, directs the department to submit an amendment to the state medical assistance plan and to request any waivers necessary to implement the program. Specifies the eligibility requirements for the program.

Requires the medical services board to promulgate rules to implement the program, including specifying the amount of the premium determined from a sliding-fee scale to buy into medicaid. Directs that the rules and premiums be based on the actuarial study.

Appropriates $27,500 from the general fund to the department for implementation of the act. Anticipates that the department will receive an additional amount of $27,500 in federal funds to implement the act.

APPROVED by Governor June 5, 2008
EFFECTIVE June 5, 2008

H.B. 08-1094 Medicaid - advanced practice nurses - direct reimbursement. Authorizes payment to an advanced practice nurse for services provided under the "Colorado Medical Assistance Act". Requires reimbursement for services to be made directly to the advanced practice nurse upon request, except when the services are provided within the scope of employment of a salaried employee of a public or private institution or a physician.

APPROVED by Governor March 20, 2008
EFFECTIVE July 1, 2008

H.B. 08-1114 Medicaid - Class I nursing facility providers - reimbursement methods - provider fee - appropriation. Changes the method of reimbursing class I nursing facilities under medicaid including:

● Establishing per diem rates for the actual cost of direct and indirect health care services and raw food subject to a maximum amount and adjusted based upon the acuity or case-mix of recipients;

● Providing for additional per diem rates for administrative and general services costs and fair rental allowance;

● Providing for additional per diem rates based upon performance measures;

● Providing for additional per diem rates for residents with a mental health condition, cognitive dementia, or acquired brain injury; and

● Providing for additional per diem rates to offset the provider fee.

Includes allowances for inflation in certain categories, and limits increases in certain categories to 3% per year. Specifies that the reimbursements for performance measures, mental health condition, cognitive dementia, or acquired brain injury, and the provider fee offset are to be paid solely from the provider fees and any associated federal moneys.

Authorizes the department of health care policy and financing ("department"), subject to the receipt of any necessary federal waivers, to charge and collect a provider fee from specified nursing facilities. Specifies that the provider fees are to be credited to a new cash fund and shall be appropriated only to assist in the payment of the per diem rates to class I facilities.

Repeals the statute that provided for the feasibility study of a new reimbursement system for class I nursing facilities.

If the executive director of the department does not submit a notice to the revisor of statutes by March 31, 2009, that the federal government has approved the waiver authorizing provider fees, appropriates $119,968 and 1.3 FTE from the general fund to the department for the executive director's office. If the executive director of the department submits a notice to the revisor of statutes by March 31, 2009, that the federal government has approved the waiver authorizing provider fees, appropriates $127,461 and 1.3 FTE from the general fund to the department for the executive director's office and appropriates $5,927,160 from the medicaid nursing facility cash fund to the department for medical services premiums.

APPROVED by Governor June 2, 2008
PORTIONS EFFECTIVE June 2, 2008
PORTIONS EFFECTIVE April 1, 2009

H.B. 08-1150 Medicaid - complementary or alternative therapy - pilot program. Establishes a pilot program to provide complementary or alternative therapies to an eligible person with a disability ("pilot program"). Limits complementary or alternative therapies to chiropractic care, massage therapy, and acupuncture. Defines eligible persons. Directs the medical services board to adopt rules to administer the pilot program. Requires the department of health care policy and financing to report to specified committees of the general assembly. Repeals the pilot program, effective September 1, 2014.

VETOED by Governor June 5, 2008

H.B. 08-1203 Licensed hospitals - transactions - material change - consideration. For purposes of the laws relating to transactions involving licensed hospitals, requires the attorney general to consider, among other factors, the reduction in the accessibility or availability of health care services in the communities served by a hospital in determining whether a material change exists in the charitable purposes to which the assets of the hospital have been dedicated.

APPROVED by Governor May 27, 2008
EFFECTIVE August 5, 2008
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 08-1373 Breast and cervical cancer prevention and treatment program - fund - appropriation. For purposes of funding the breast and cervical cancer prevention and treatment program ("program"), appropriates 100% of the state costs of the program from the breast and cervical cancer prevention and treatment fund ("fund") for fiscal years 2007-08 and 2008-09. Appropriates 50% of the state costs of the program from the general fund and 50% of the state costs of the program from the moneys credited to the fund for fiscal years 2009-10 through 2013-14. Extends the repeal date for the program until July 1, 2014.

Makes appropriate adjustments in the moneys appropriated for the program in fiscal years 2007-08 and 2008-09.

APPROVED by Governor June 2, 2008
EFFECTIVE June 2, 2008

H.B. 08-1374 Medicaid - all-inclusive care for the elderly - cap - repeal - appropriation. Repeals the cap based on fee-for-service costs on the capitated rate under the program of all-inclusive care for the elderly.

Appropriates $1,567,464 to the department of health care policy and financing for medical services premiums, and anticipates receipt of an equal amount in federal funds.

APPROVED by Governor June 2, 2008
EFFECTIVE June 2, 2008

H.B. 08-1409 Medicaid - third party liability - legislative declaration - appropriation. Specifies that the department of health care policy and financing ("department") is authorized to determine whether a health insurance plan or other third-party payor ("third party") is liable for payment for services provided to a medicaid recipient. Provides that benefits for a recipient who knowingly or wilfully fails to provide information concerning the liability of third parties may be terminated.

Requires a third party that may be liable for payment of services provided to a medicaid recipient:

● To provide the department or the department's business associate on a monthly basis the minimum information concerning the eligibility of persons covered by the third party to determine if a medicaid recipient is covered by the third party;

● To accept the state's right to recover for services provided to medicaid recipients;

● To respond to inquiries from the department concerning benefits available from the third party; and

● To agree not to deny claims of the department based upon specified criteria.

Provides a private right of action against a department's business associate that negligently uses the data for an unauthorized purpose. States that it is the intent of the general assembly that the medical assistance program be the last resort for payment for benefits furnished to recipients.

Decreases the appropriation to the department of health care policy and financing, division of medical services premiums, for medical service premiums, contained in the annual general appropriations act by $300,000.

APPROVED by Governor June 2, 2008
EFFECTIVE June 2, 2008