A Bill for an Act
Page 1, Line 101Concerning nursing facility fees collected by the Colorado
Page 1, Line 102healthcare affordability and sustainability
Page 1, Line 103enterprise, and, in connection therewith, authorizing
Page 1, Line 104the enterprise to provide additional services to
Page 1, Line 105nursing facilities in exchange for the fees collected
Page 1, Line 106and making and reducing appropriations.
Bill Summary
(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)
The bill repeals the existing nursing facility provider fee and intermediate care facility service fee, effective May 1, 2025, and provides that, beginning on May 1, 2025, and for each state fiscal year thereafter, the Colorado healthcare affordability and sustainability enterprise (CHASE) within the department of health care policy and financing will charge and collect a new healthcare affordability and sustainability nursing facility provider fee and a new healthcare affordability and sustainability intermediate care facility fee that function similarly to the repealed fees. The bill creates a facility provider fee enterprise support board within CHASE for the purpose of supporting the existing enterprise with the implementation of the healthcare affordability and sustainability nursing facility provider fee and the healthcare affordability and sustainability intermediate care facility fee. In exchange for payment of the healthcare affordability and sustainability nursing facility provider fee, CHASE will provide certain business services to nursing facility providers to sustain or increase reimbursement rates and make supplemental medicaid payments to nursing facility providers. In exchange for payment of the healthcare affordability and sustainability intermediate care facility fee, CHASE will provide certain business services to intermediate care facility providers for individuals with intellectual disabilities for the purposes of maintaining the quality and continuity of services provided by intermediate care facilities for individuals with intellectual disabilities. Because CHASE is an enterprise for purposes of the Taxpayer's Bill of Rights, its revenue does not count against the state fiscal year spending limit.
The bill also makes conforming amendments and, for clarity, renames the existing healthcare affordability and sustainability fee and healthcare affordability and sustainability fund to be the healthcare affordability and sustainability hospital provider fee and the healthcare affordability and sustainability hospital provider fee cash fund.
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. In Colorado Revised Statutes, 25.5-4-402.4, amend
Page 2, Line 3(2) introductory portion, (2)(a), (2)(c) introductory portion, (2)(c)(V),
Page 2, Line 4(2)(c)(VI), (2)(d) introductory portion, (2)(e), (2)(f), (2)(g), (3)(a),
Page 2, Line 5(3)(c)(I), (3)(d)(I), (3)(d)(II), (3)(d)(III), (3)(d)(V), (4)(b) introductory
Page 2, Line 6portion, (4)(b)(II), (4)(b)(III), (4)(c)(I) introductory portion, (4)(c)(II)(C),
Page 2, Line 7(4)(c)(III) introductory portion, (4)(c)(III)(E), (4)(c)(III)(F), (4)(e), (4)(f),
Page 2, Line 8(5)(a), (5)(b) introductory portion, (5)(b)(IV) introductory portion,
Page 3, Line 1(5)(b)(VI)(B), (5)(c)(I)(A), (5)(c)(II)(C), (5)(c)(III), (5)(c)(V), (6)(a)(I),
Page 3, Line 2(6)(b) introductory portion, (6)(b)(II), (6)(b)(III)(A), (6)(b)(III)(B), (6)(c),
Page 3, Line 3(7)(b), (7)(d)(I), (7)(d)(II), (7)(d)(III), (7)(d)(IX), (7)(d)(X), (7)(e)
Page 3, Line 4introductory portion, (7)(e)(II), (7)(e)(III) introductory portion, and
Page 3, Line 5(7)(e)(IV); amend as they exist until July 1, 2025, (2)(d)(I), (4)(a)
Page 3, Line 6introductory portion, and (4)(g); and add (2)(c)(V.5), (2)(c)(V.7),
Page 3, Line 7(2)(d.5), (2)(d.7), (3)(c)(III), (3)(c)(IV), (4.5), (4.7), (5.5), (5.7),
Page 3, Line 8(6)(a)(IV), (6)(a)(V), (6)(b.5), (6)(c.5), (6)(c.7), (7)(e)(II.5), (7)(e)(II.7), (7)(e)(III.5), (7)(e)(III.7), (7)(g), and (9) as follows:
Page 3, Line 925.5-4-402.4. Healthcare affordability and sustainability
Page 3, Line 10hospital provider fee - healthcare affordability and sustainability
Page 3, Line 11nursing facility provider fee - healthcare affordability and
Page 3, Line 12sustainability intermediate care facility fee - Colorado healthcare
Page 3, Line 13affordability and sustainability enterprise - federal waiver - funds
Page 3, Line 14created - reports - rules - legislative declaration - repeal.
Page 3, Line 15(2) Legislative declaration. The general assembly hereby
Page 3, Line 16(a) The state and the providers of publicly funded medical
Page 3, Line 17services, and hospitals, nursing facility providers, and intermediate
Page 3, Line 18care facilities for individuals with intellectual disabilities in
Page 3, Line 19particular, share a common commitment to comprehensive health-care reform;
Page 3, Line 20(c) This section is enacted as part of a comprehensive health-care
Page 3, Line 21reform and is intended to provide the following services and benefits to
Page 3, Line 22hospitals, nursing facility providers, intermediate care facilities for individuals with intellectual disabilities, and individuals:
Page 3, Line 23(V) Expanding access to high-quality, affordable health care for low-income and uninsured populations; and
Page 4, Line 1(V.5) Sustaining or increasing the reimbursement for
Page 4, Line 2providing medical care under the state's medical assistance
Page 4, Line 3program for nursing facility providers and making supplemental medicaid payments to nursing facility providers;
Page 4, Line 4(V.7) Maintaining the quality and continuity of services
Page 4, Line 5provided by intermediate care facilities for individuals with intellectual disabilities; and
Page 4, Line 6(VI) Providing the additional business services specified in
Page 4, Line 7subsection (4)(a)(IV) of this section to hospitals that pay the healthcare
Page 4, Line 8affordability and sustainability hospital provider fee charged and
Page 4, Line 9collected as authorized by subsection (4) of this section by the Colorado
Page 4, Line 10healthcare affordability and sustainability enterprise created in subsection (3)(a) of this section;
Page 4, Line 11(d) The Colorado healthcare affordability and sustainability
Page 4, Line 12enterprise provides business services to hospitals when, in exchange for
Page 4, Line 13payment of healthcare affordability and sustainability hospital provider fees by hospitals, it:
Page 4, Line 14(I) Obtains federal matching money and returns both the
Page 4, Line 15healthcare affordability and sustainability
Page 4, Line 16federal matching money to hospitals to increase reimbursement rates to
Page 4, Line 17hospitals for providing medical care under the state medical assistance
Page 4, Line 18program and the Colorado indigent care program and to increase the number of individuals covered by public medical assistance; and
Page 4, Line 19(d.5) The Colorado healthcare affordability and
Page 4, Line 20sustainability enterprise provides business services to nursing
Page 4, Line 21facility providers when, in exchange for payment of nursing
Page 5, Line 1facility provider fees, it obtains federal matching money and
Page 5, Line 2returns both the nursing facility provider fee and the federal
Page 5, Line 3matching money to nursing facility providers to sustain or
Page 5, Line 4increase reimbursement rates and make supplemental medicaid payments to nursing facility providers;
Page 5, Line 5(d.7) The Colorado healthcare affordability and
Page 5, Line 6sustainability enterprise provides business services to
Page 5, Line 7intermediate care facilities for individuals with intellectual
Page 5, Line 8disabilities when, in exchange for payment of intermediate care
Page 5, Line 9facility fees, it obtains federal matching money and returns
Page 5, Line 10both the intermediate care facility fee and the federal
Page 5, Line 11matching money to intermediate care facilities for individuals
Page 5, Line 12with intellectual disabilities to sustain or increase
Page 5, Line 13reimbursement rates and make supplemental medicaid payments to such intermediate care facilities;
Page 5, Line 14(e) It is necessary, appropriate, and in the best interest of the state
Page 5, Line 15to acknowledge that by providing the business services specified in
Page 5, Line 16subsections (2)(d)(I) and (2)(d)(II)
Page 5, Line 17section, the Colorado healthcare affordability and sustainability enterprise
Page 5, Line 18engages in an activity conducted in the pursuit of a benefit, gain, or livelihood and therefore operates as a business;
Page 5, Line 19(f) Consistent with the determination of the Colorado supreme
Page 5, Line 20court in Nicholl v. E-470 Public Highway Authority, 896 P.2d 859 (Colo.
Page 5, Line 211995), that the power to impose taxes is inconsistent with enterprise status
Page 5, Line 22under section 20 of article X of the state constitution, it is the conclusion
Page 5, Line 23of the general assembly that the healthcare affordability and sustainability
Page 5, Line 24hospital provider fee, the healthcare affordability and
Page 6, Line 1sustainability nursing facility provider fee, and the healthcare
Page 6, Line 2affordability and sustainability intermediate care facility fee
Page 6, Line 3charged and collected by the Colorado healthcare affordability and
Page 6, Line 4sustainability enterprise is a feea tax
Page 6, Line 5fee is
Page 6, Line 6enterprise to defray the costs of providing the business services specified
Page 6, Line 7in subsections (2)(d)(I) and (2)(d)(II)
Page 6, Line 8this section to hospitals, nursing facility providers, and
Page 6, Line 9intermediate care facilities for individuals with intellectual
Page 6, Line 10disabilities that pay the feeis
Page 6, Line 11reasonably calculated based on the benefits received by those hospitals, nursing facility providers, and intermediate care facilities; and
Page 6, Line 12(g) So long as the Colorado healthcare affordability and
Page 6, Line 13sustainability enterprise qualifies as an enterprise for purposes of section
Page 6, Line 1420 of article X of the state constitution, the revenues from the healthcare
Page 6, Line 15affordability and sustainability fee
Page 6, Line 16enterprise are not state fiscal year spending, as defined in section
Page 6, Line 1724-77-102 (17), or state revenues, as defined in section 24-77-103.6
Page 6, Line 18(6)(c), and do not count against either the state fiscal year spending limit
Page 6, Line 19imposed by section 20 of article X of the state constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I).
Page 6, Line 20(3) Colorado healthcare affordability and sustainability
Page 6, Line 21enterprise. (a) The Colorado healthcare affordability and sustainability
Page 6, Line 22enterprise referred to in this section as the "enterprise",
Page 6, Line 23enterprise is and operates as a government-owned business within the state department for the purpose of:
Page 6, Line 24(I) Charging and collecting:
Page 7, Line 1(A) The healthcare affordability and sustainability
Page 7, Line 2(B) The nursing facility provider fee; and
(C) The intermediate care facility fee;
Page 7, Line 3(II) Leveraging healthcare affordability and sustainability
Page 7, Line 4revenue from thehospital provider fee, revenue
Page 7, Line 5facility provider fee, and the intermediate care facility fee to obtain federal matching money; and
Page 7, Line 6(III) Utilizing and deploying:
Page 7, Line 7(A) The healthcare affordability and sustainability
Page 7, Line 8provider fee revenue and federal matching money to provide the
Page 7, Line 9business services specified in subsections (2)(d)(I) and (2)(d)(II) of this
Page 7, Line 10section to hospitals that pay the healthcare affordability and sustainability fee;
Page 7, Line 11(B) The nursing facility provider fee revenue and any
Page 7, Line 12federal matching money to provide the business services
Page 7, Line 13specified in subsection (2)(d.5) of this section to nursing facility providers that pay the nursing facility provider fee; and
Page 7, Line 14(C) The intermediate care facility fee revenue and any
Page 7, Line 15federal matching money to provide the business services
Page 7, Line 16specified in subsection (2)(d.7) of this section to intermediate
Page 7, Line 17care facilities for individuals with intellectual disabilities that pay the intermediate care facility fee.
Page 7, Line 18(c) (I) The repeal of the hospital provider fee program, as it
Page 7, Line 19existed pursuant to section 25.5-4-402.3 before its repeal, effective July
Page 7, Line 201, 2017, by Senate Bill 17-267, enacted in 2017, and the creation of the
Page 7, Line 21Colorado healthcare affordability and sustainability enterprise as a new
Page 8, Line 1enterprise to charge and collect a new healthcare affordability and
Page 8, Line 2sustainability hospital provider fee as authorized by subsection (4) of
Page 8, Line 3this section and provide healthcare affordability and sustainability
Page 8, Line 4fee-funded business services to hospitals that replace and supplement
Page 8, Line 5services previously funded by the repealed hospital provider fees is the
Page 8, Line 6creation of a new government-owned business that provides business
Page 8, Line 7services to hospitals as a new enterprise for purposes of section 20 of
Page 8, Line 8article X of the state constitution, does not constitute the qualification of
Page 8, Line 9an existing government-owned business as an enterprise for purposes of
Page 8, Line 10section 20 of article X of the state constitution or section 24-77-103.6
Page 8, Line 11(6)(b)(II), and, therefore, does not require or authorize adjustment of the
Page 8, Line 12state fiscal year spending limit calculated pursuant to section 20 of article
Page 8, Line 13X of the state constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I).
Page 8, Line 14(III) The repeal of the nursing facility provider fee
Page 8, Line 15program, as it existed in section 25.5-6-203 (1) before its repeal,
Page 8, Line 16effective May 1, 2025, by Senate Bill 25-270, enacted in 2025, and
Page 8, Line 17the enterprise's ability to charge and collect a new healthcare
Page 8, Line 18affordability and sustainability nursing facility provider fee as
Page 8, Line 19authorized by subsection (4.5) of this section and provide
Page 8, Line 20fee-funded business services to nursing facility providers that
Page 8, Line 21replace and supplement services previously funded by the
Page 8, Line 22nursing facility provider fee does not constitute creation of a
Page 8, Line 23new enterprise or the qualification of an existing
Page 8, Line 24government-owned business as an enterprise for purposes of
Page 8, Line 25section 20 of article X of the state constitution, section
Page 8, Line 2624-77-103.6 (6)(b)(II), or section 24-77-108, and, therefore, does
Page 9, Line 1not require or authorize adjustment of the state fiscal year
Page 9, Line 2spending limit calculated pursuant to section 20 of article X of
Page 9, Line 3the state constitution or the excess state revenues cap, as
Page 9, Line 4defined in section 24-77-103.6 (6)(b)(I), and does not require voter approval.
Page 9, Line 5(IV) The repeal of the intermediate care facility service
Page 9, Line 6fee program, as it existed in section 25.5-6-204 (1)(c)(I) before its
Page 9, Line 7repeal, effective May 1, 2025, by Senate Bill 25-270, enacted in
Page 9, Line 82025, and the enterprise's ability to charge and collect a new
Page 9, Line 9healthcare affordability and sustainability intermediate care
Page 9, Line 10facility fee as authorized by subsection (4.7) of this section and
Page 9, Line 11provide fee-funded business services to intermediate care
Page 9, Line 12facilities for individuals with intellectual disabilities that
Page 9, Line 13replace and supplement services previously funded by the
Page 9, Line 14intermediate care facility service fee does not constitute
Page 9, Line 15creation of a new enterprise or the qualification of an existing
Page 9, Line 16government-owned business as an enterprise for purposes of
Page 9, Line 17section 20 of article X of the state constitution, section
Page 9, Line 1824-77-103.6 (6)(b)(II), or section 24-77-108, and, therefore, does
Page 9, Line 19not require or authorize adjustment of the state fiscal year
Page 9, Line 20spending limit calculated pursuant to section 20 of article X of
Page 9, Line 21the state constitution or the excess state revenues cap, as
Page 9, Line 22defined in section 24-77-103.6 (6)(b)(I), and does not require voter approval.
Page 9, Line 23(d) The enterprise's primary powers and duties are:
(I) To charge and collect:
Page 9, Line 24(A) The healthcare affordability and sustainability
Page 10, Line 1(B) The nursing facility provider fee as specified in subsection (4.5) of this section; and
Page 10, Line 2(C) The intermediate care facility fee as specified in subsection (4.7) of this section;
Page 10, Line 3(II) To leverage healthcare affordability and sustainability
Page 10, Line 4revenue from the hospital provider fee, revenue collected
Page 10, Line 5nursing facility provider fee, and the intermediate care facility
Page 10, Line 6fee to obtain federal matching money, working with or through the state
Page 10, Line 7department and the state board to the extent required by federal law or otherwise necessary;
Page 10, Line 8(III) To expend:
Page 10, Line 9(A) healthcare affordability and sustainability
Page 10, Line 10fee revenue, matching federal money, and any other money from the
Page 10, Line 11healthcare affordability and sustainability
Page 10, Line 12(B) Nursing facility provider fee revenue, matching
Page 10, Line 13federal money, and any other money from the nursing facility
Page 10, Line 14provider fee cash fund as specified in subsection (5.5) of this section; and
Page 10, Line 15(C) Intermediate care facility fee revenue, matching
Page 10, Line 16federal money, and any other money from the intermediate care
Page 10, Line 17facility fee cash fund as specified in subsection (5.7) of this section;
Page 10, Line 18(V) To enter into agreements with the state department to the
Page 10, Line 19extent necessary to collect and expend healthcare affordability and
Page 10, Line 20sustainabilityrevenue
Page 11, Line 1nursing facility provider fee, and the intermediate care facility fee;
Page 11, Line 2(4) Healthcare affordability and sustainability hospital
Page 11, Line 3provider fee. (a) For the fiscal year commencing July 1, 2017, and for
Page 11, Line 4each fiscal year thereafter, the enterprise is authorized to charge and
Page 11, Line 5collect a healthcare affordability and sustainability hospital provider
Page 11, Line 6fee, as described in 42 CFR 433.68 (b), on outpatient and inpatient
Page 11, Line 7services provided by all licensed or certified hospitals referred to in this
Page 11, Line 8section as "hospitals",
Page 11, Line 9participation under the state medical assistance program as described in
Page 11, Line 10this article 4 and articles 5 and 6 of this title 25.5 referred to in this
Page 11, Line 11section as the "state medical assistance program",
Page 11, Line 12indigent care program described in part 1 of article 3 of this title 25.5,
Page 11, Line 13referred to in this section as the "Colorado indigent care program". If the
Page 11, Line 14amount of healthcare affordability and sustainability
Page 11, Line 15fee revenue collected exceeds the federal net patient revenue-based limit
Page 11, Line 16on the amount of such fee revenue that may be collected, requiring
Page 11, Line 17repayment to the federal government of excess federal matching money
Page 11, Line 18received, hospitals that received such excess federal matching money
Page 11, Line 19shall be responsible for repaying the excess federal money and any
Page 11, Line 20associated federal penalties to the federal government. The enterprise
Page 11, Line 21shall use the healthcare affordability and sustainability
Page 11, Line 22(b) The enterprise shall recommend for approval and
Page 11, Line 23establishment by the state board the amount of the healthcare affordability
Page 11, Line 24and sustainability
Page 11, Line 25collect. The state board must establish the final amount of the fee by rules
Page 12, Line 1promulgated in accordance with article 4 of title 24. The state board shall
Page 12, Line 2not establish any amount that exceeds the federal limit for such fees. The
Page 12, Line 3state board may deviate from the recommendations of the enterprise, but
Page 12, Line 4shall express in writing the reasons for any deviations. In establishing the
Page 12, Line 5amount of the fee and in promulgating the rules governing the fee, the state board shall:
Page 12, Line 6(II) Establish the amount of the healthcare affordability and
Page 12, Line 7sustainability
Page 12, Line 8the fee and federal matching funds associated with the fee are sufficient
Page 12, Line 9to pay for the items described in subsection (4)(a) of this section, but
Page 12, Line 10nothing in this subsection (4)(b)(II) requires the state board to increase the fee above the amount recommended by the enterprise; and
Page 12, Line 11(III) For the 2017-18 fiscal year, establish the amount of the
Page 12, Line 12healthcare affordability and sustainability
Page 12, Line 13the amount collected from the fee is approximately equal to the sum of
Page 12, Line 14the amounts of the appropriations specified for the fee in the general
Page 12, Line 15appropriation act, Senate Bill 17-254, enacted in 2017, and any other supplemental appropriation act.
Page 12, Line 16(c) (I) In accordance with the redistributive method set forth in 42
Page 12, Line 17CFR 433.68 (e)(1) and (e)(2), the enterprise, acting in concert with or
Page 12, Line 18through an agreement with the state department if required by federal law,
Page 12, Line 19may seek a waiver from the broad-based healthcare affordability and
Page 12, Line 20sustainability
Page 12, Line 21healthcare affordability and sustainability
Page 12, Line 22requirement, or both. In addition, the enterprise, acting in concert with or
Page 12, Line 23through an agreement with the state department if required by federal law,
Page 12, Line 24shall seek any federal waiver necessary to fund and, in cooperation with
Page 13, Line 1the state department and hospitals, support the implementation of a
Page 13, Line 2health-care delivery system reform incentive payments program as
Page 13, Line 3described in subsection (8) of this section. Subject to federal approval and
Page 13, Line 4to minimize the financial impact on certain hospitals, the enterprise may
Page 13, Line 5exempt from payment of the healthcare affordability and sustainability
Page 13, Line 6hospital provider fee certain types of hospitals, including but not limited to:
Page 13, Line 7(II) In determining whether a hospital may be excluded, the enterprise shall use one or more of the following criteria:
Page 13, Line 8(C) A hospital whose inclusion or exclusion would not
Page 13, Line 9significantly affect the net benefit to hospitals paying the healthcare affordability and sustainability
Page 13, Line 10(III) The enterprise may reduce the amount of the healthcare
Page 13, Line 11affordability and sustainability
Page 13, Line 12hospitals to obtain federal approval and to minimize the financial impact
Page 13, Line 13on certain hospitals. In determining for which hospitals the enterprise may
Page 13, Line 14reduce the amount of the healthcare affordability and sustainability
Page 13, Line 15hospital provider fee, the enterprise shall use one or more of the following criteria:
Page 13, Line 16(E) If the hospital paid a reduced healthcare affordability and
Page 13, Line 17sustainability
Page 13, Line 18significantly affect the net benefit to hospitals paying the healthcare affordability and sustainability
Page 13, Line 19(F) The hospital is required not to pay a reduced healthcare
Page 13, Line 20affordability and sustainability
Page 13, Line 21(e) (I) The enterprise shall establish policies on the calculation,
Page 14, Line 1assessment, and timing of the healthcare affordability and sustainability
Page 14, Line 2hospital provider fee. The enterprise shall assess the healthcare
Page 14, Line 3affordability and sustainability
Page 14, Line 4be set by the enterprise board as provided in subsection (7)(d) of this
Page 14, Line 5section. The periodic healthcare affordability and sustainability
Page 14, Line 6provider fee payments from a hospital and the enterprise's
Page 14, Line 7reimbursement to the hospital under subsections (5)(b)(I) and (5)(b)(II)
Page 14, Line 8of this section are due as nearly simultaneously as feasible; except that the
Page 14, Line 9enterprise's reimbursement to the hospital is due no more than two days
Page 14, Line 10after the periodic healthcare affordability and sustainability
Page 14, Line 11provider fee payment is received from the hospital. The healthcare
Page 14, Line 12affordability and sustainability
Page 14, Line 13on each hospital even if more than one hospital is owned by the same
Page 14, Line 14entity. The fee must be prorated and adjusted for the expected volume of service for any year in which a hospital opens or closes.
Page 14, Line 15(II) The enterprise is authorized to refund any unused portion of
Page 14, Line 16the healthcare affordability and sustainability
Page 14, Line 17any portion of the healthcare affordability and sustainability
Page 14, Line 18provider fee that has been collected by the enterprise but for which the
Page 14, Line 19enterprise has not received federal matching funds, the enterprise shall
Page 14, Line 20refund back to the hospital that paid the fee the amount of that portion of the fee within five business days after the fee is collected.
Page 14, Line 21(III) The enterprise shall establish requirements for the reports that
Page 14, Line 22hospitals must submit to the enterprise to allow the enterprise to calculate
Page 14, Line 23the amount of the healthcare affordability and sustainability
Page 14, Line 24provider fee. Notwithstanding the provisions of part 2 of article 72 of
Page 14, Line 25title 24 or subsection (7)(f) of this section, information provided to the
Page 15, Line 1enterprise pursuant to this section is confidential and is not a public
Page 15, Line 2record. Nonetheless, the enterprise may prepare and release summaries of the reports to the public.
Page 15, Line 3(f) A hospital shall not include any amount of the healthcare
Page 15, Line 4affordability and sustainability
Page 15, Line 5(g) The state board shall promulgate any rules pursuant to the
Page 15, Line 6"State Administrative Procedure Act", article 4 of title 24, necessary for
Page 15, Line 7the administration and implementation of this section. Prior to submitting
Page 15, Line 8any proposed rules concerning the administration or implementation of
Page 15, Line 9the healthcare affordability and sustainability
Page 15, Line 10the state board, the enterprise shall consult with the state board on the proposed rules as specified in subsection (7)(d) of this section.
Page 15, Line 11(4.5) Healthcare affordability and sustainability nursing
Page 15, Line 12facility provider fee. (a) Beginning on May 1, 2025, the enterprise
Page 15, Line 13is authorized to charge and collect a healthcare affordability
Page 15, Line 14and sustainability nursing facility provider fee on health-care
Page 15, Line 15items or services provided by nursing facility providers for the
Page 15, Line 16purpose of obtaining federal financial participation under the
Page 15, Line 17state medical assistance program as described in this article 4
Page 15, Line 18and articles 5 and 6 of this title 25.5. The enterprise shall use
Page 15, Line 19the nursing facility provider fee revenue to provide a business
Page 15, Line 20service to nursing facility providers by sustaining or increasing
Page 15, Line 21reimbursement for providing medical care under the state
Page 15, Line 22medical assistance program for nursing facility providers and
Page 15, Line 23making supplemental medicaid payments to nursing facility
Page 15, Line 24providers, as specified by the priority of the uses of the nursing
Page 16, Line 1facility provider fee revenue set forth in subsection (5.5)(b) of this section.
Page 16, Line 2(b) The enterprise shall recommend for approval and
Page 16, Line 3establishment by the state board the amount of the nursing
Page 16, Line 4facility provider fee that it intends to charge and collect. The
Page 16, Line 5state board must establish the final amount of the fee by rule.
Page 16, Line 6The state board shall not establish any amount that exceeds
Page 16, Line 7the federal limit for such fees. The state board may deviate
Page 16, Line 8from the recommendations of the enterprise, but shall express
Page 16, Line 9in writing the reasons for any deviations. In establishing the
Page 16, Line 10amount of the fee and in promulgating the rules governing the fee, the state board shall:
Page 16, Line 11(I) Consider recommendations of the enterprise; and
Page 16, Line 12(II) Establish the amount of the nursing facility provider
Page 16, Line 13fee so that the amount collected from the fee and federal
Page 16, Line 14matching funds associated with the fee are sufficient to pay for
Page 16, Line 15the items described in subsection (4.5)(a) of this section, but
Page 16, Line 16nothing in this subsection (4.5)(b)(II) requires the state board to
Page 16, Line 17increase the fee above the amount recommended by the enterprise.
Page 16, Line 18(c) The enterprise shall not charge or collect the nursing
Page 16, Line 19facility provider fee in the absence of the federal government's
Page 16, Line 20approval of a state medicaid plan amendment authorizing
Page 16, Line 21federal financial participation for the nursing facility provider
Page 16, Line 22fee. The enterprise may alter the process prescribed in this
Page 16, Line 23subsection (4.5) to the extent necessary to meet federal
Page 16, Line 24requirements and to obtain federal approval. The enterprise
Page 17, Line 1may lower the amount of the nursing facility provider fee
Page 17, Line 2charged to certain nursing facility providers to meet the
Page 17, Line 3requirements of 42 CFR 433.68 (e) and to obtain federal approval.
Page 17, Line 4(d) (I) In accordance with the redistributive method set
Page 17, Line 5forth in 42 CFR 433.68 (e)(1) and (e)(2), the enterprise, acting in
Page 17, Line 6concert with or through an agreement with the state
Page 17, Line 7department if required by federal law, may seek a waiver from
Page 17, Line 8the broad-based nursing facility provider fee requirement or the uniform nursing facility provider fee requirement, or both.
Page 17, Line 9(II) Subject to federal approval and to minimize the
Page 17, Line 10financial impact on certain nursing facility providers, the
Page 17, Line 11enterprise may exempt from payment of the nursing facility
Page 17, Line 12provider fee certain types of nursing provider facilities, including but not limited to:
Page 17, Line 13(A) A facility operated as a continuing care retirement
Page 17, Line 14community that provides a continuum of services by one
Page 17, Line 15operational entity providing independent living services,
Page 17, Line 16assisted living services, and skilled nursing care on a single,
Page 17, Line 17contiguous campus. Assisted living services include an assisted
Page 17, Line 18living residence as defined in section 25-27-102 or a facility that
Page 17, Line 19provides assisted living services on-site, twenty-four hours per day, seven days per week.
Page 17, Line 20(B) A skilled nursing facility owned and operated by the state;
Page 17, Line 21(C) A nursing facility that is a distinct part of a facility
Page 17, Line 22that is licensed as a general acute care hospital; and
(D) A facility that has forty-five or fewer licensed beds.
Page 18, Line 1(e) (I) The enterprise shall establish policies on the
Page 18, Line 2calculation, assessment, and timing of the nursing facility
Page 18, Line 3provider fee. The enterprise shall assess the nursing facility
Page 18, Line 4provider fee on a monthly basis. The nursing facility provider
Page 18, Line 5fee payments from a nursing facility provider and the
Page 18, Line 6enterprise's reimbursement and supplemental payments to the
Page 18, Line 7nursing facility provider under subsection (5.5)(b) of this section
Page 18, Line 8are due as nearly simultaneously as feasible; except that the
Page 18, Line 9enterprise's reimbursement and supplemental payments to the
Page 18, Line 10nursing facility provider are due no more than fifteen days
Page 18, Line 11after the nursing facility provider fee payment is received from the nursing facility provider.
Page 18, Line 12(II) The enterprise shall establish requirements for the
Page 18, Line 13reports that nursing facility providers must submit to the
Page 18, Line 14enterprise to allow the enterprise to calculate the amount of
Page 18, Line 15the nursing facility provider fee, including a requirement that
Page 18, Line 16each nursing facility provider report annually its total number
Page 18, Line 17of days of care provided to nonmedicare residents.
Page 18, Line 18Notwithstanding part 2 of article 72 of title 24 or subsection
Page 18, Line 19(7)(f) of this section, information provided to the enterprise
Page 18, Line 20pursuant to this subsection (4.5)(e)(II) is confidential and is not
Page 18, Line 21a public record. Nonetheless, the enterprise may prepare and release summaries of the reports to the public.
Page 18, Line 22(f) A nursing facility provider shall not include any
Page 18, Line 23amount of the nursing facility provider fee as a separate line
Page 18, Line 24item in its billing statements.
Page 19, Line 1(g) (I) The state board shall adopt any rules pursuant to
Page 19, Line 2the "State Administrative Procedure Act", article 4 of title 24,
Page 19, Line 3necessary for the administration and implementation of this
Page 19, Line 4section. Prior to submitting any proposed rules concerning the
Page 19, Line 5administration or implementation of the nursing facility
Page 19, Line 6provider fee to the state board, the enterprise shall consult
Page 19, Line 7with the state board on the proposed rules as specified in subsection (7)(g) of this section.
Page 19, Line 8(4.7) Healthcare affordability and sustainability intermediate
Page 19, Line 9care facility fee. (a) Beginning on May 1, 2025, the enterprise is
Page 19, Line 10authorized to charge and collect a healthcare affordability
Page 19, Line 11and sustainability intermediate care facility fee on both
Page 19, Line 12privately owned and state-operated intermediate care facilities
Page 19, Line 13for individuals with intellectual disabilities for the purpose of
Page 19, Line 14maintaining the quality and continuity of services provided by
Page 19, Line 15intermediate care facilities for individuals with intellectual
Page 19, Line 16disabilities. The enterprise shall use the intermediate care
Page 19, Line 17facility fee revenue to provide a business service to such
Page 19, Line 18intermediate care facilities by sustaining or increasing
Page 19, Line 19reimbursement to such facilities, as specified in subsection(5.7)(b) of this section.
Page 19, Line 20(b) The enterprise shall recommend for approval and
Page 19, Line 21establishment by the state board the amount of the
Page 19, Line 22intermediate care facility fee that it intends to charge and
Page 19, Line 23collect, which must not exceed five percent of the total costs
Page 19, Line 24incurred by all intermediate care facilities for the fiscal year
Page 19, Line 25in which the fee is charged. The state board must establish the
Page 20, Line 1final amount of the fee by rule. The state board shall not
Page 20, Line 2establish any amount that exceeds the federal limit for such
Page 20, Line 3fees. The state board may deviate from the recommendations of
Page 20, Line 4the enterprise, but shall express in writing the reasons for any deviations.
Page 20, Line 5(c) The enterprise may alter the process prescribed in this
Page 20, Line 6subsection (4.7) to the extent necessary to meet federal requirements.
Page 20, Line 7(d) (I) The enterprise shall establish policies on the
Page 20, Line 8calculation, assessment, and timing of the intermediate care facility fee.
Page 20, Line 9(II) The enterprise shall establish requirements for the
Page 20, Line 10reports that intermediate care facilities must submit to the
Page 20, Line 11enterprise to allow the enterprise to calculate the amount of
Page 20, Line 12the intermediate care facility fee. Notwithstanding part 2 of
Page 20, Line 13article 72 of title 24 or subsection (7)(f) of this section,
Page 20, Line 14information provided to the enterprise pursuant to this
Page 20, Line 15subsection (4.7)(d)(II) is confidential and is not a public record.
Page 20, Line 16Nonetheless, the enterprise may prepare and release summaries of the reports to the public.
Page 20, Line 17(e) The state board shall adopt any rules pursuant to the
Page 20, Line 18"State Administrative Procedure Act", article 4 of title 24,
Page 20, Line 19necessary for the administration and implementation of this
Page 20, Line 20section. Prior to submitting any proposed rules concerning the
Page 20, Line 21administration or implementation of the intermediate care
Page 20, Line 22facility fee to the state board, the enterprise shall consult
Page 20, Line 23with the state board on the proposed rules as specified in subsection (7)(g) of this section.
Page 21, Line 1(5) Healthcare affordability and sustainability hospital
Page 21, Line 2provider fee cash fund. (a) (I) Any healthcare affordability and
Page 21, Line 3sustainability hospital provider fee collected pursuant to this section
Page 21, Line 4by the enterprise must be transmitted to the state treasurer, who shall
Page 21, Line 5credit the fee to the healthcare affordability and sustainability hospital
Page 21, Line 6provider fee cash fund, which fund is herebyand referred to in
Page 21, Line 7this section as the "fund".
Page 21, Line 8income derived from the deposit and investment of money in the
Page 21, Line 9hospital provider fee cash fund to the fund. The state treasurer shall
Page 21, Line 10invest any money in the hospital provider fee cash fund not expended
Page 21, Line 11for the purposes specified in subsection (5)(b) of this section as provided
Page 21, Line 12by law. Money in the hospital provider fee cash fund shall not be
Page 21, Line 13transferred to any other fund and shall not be used for any purpose other
Page 21, Line 14than the purposes specified in this subsection (5) and in subsection (4) of this section.
Page 21, Line 15(II) (A) The fund created in this subsection (5)(a) was
Page 21, Line 16renamed as the healthcare affordability and sustainability
Page 21, Line 17hospital provider fee cash fund in Senate Bill 25-270, enacted in
Page 21, Line 182025. For purposes of the annual general appropriation acts for
Page 21, Line 19the 2024-25 and 2025-26 state fiscal years, the cash funds
Page 21, Line 20appropriations made to the department of health care policy
Page 21, Line 21and financing from the healthcare affordability and
Page 21, Line 22sustainability fee cash fund, as the fund was named prior to the
Page 21, Line 23enactment of Senate Bill 25-270, enacted in 2025, are from the
Page 21, Line 24healthcare affordability and sustainability hospital provider
Page 21, Line 25fee cash fund, as renamed by Senate Bill 25-270, enacted in 2025.
Page 22, Line 1(B) This subsection (5)(a)(II) is repealed, effective July 1, 2027.
Page 22, Line 2(b) All money in the hospital provider fee cash fund is subject
Page 22, Line 3to federal matching as authorized under federal law and, subject to annual
Page 22, Line 4appropriation by the general assembly, shall be expended by the enterprise for the following purposes:
Page 22, Line 5(IV) Subject to available revenue from the healthcare affordability
Page 22, Line 6and sustainability
Page 22, Line 7(VI) To pay the enterprise's actual administrative costs of
Page 22, Line 8implementing and administering this section, including but not limited to the following costs:
Page 22, Line 9(B) The enterprise's actual costs related to implementing and
Page 22, Line 10maintaining the healthcare affordability and sustainability
Page 22, Line 11provider fee, including personal services, operating, and consulting expenses;
Page 22, Line 12(c) ARPA home- and community-based services account.
Page 22, Line 13(I) (A) There is created the "ARPA home- and community-based services
Page 22, Line 14account" within the hospital provider fee cash fund, referred to in this
Page 22, Line 15subsection (5)(c) as the "ARPA account". Notwithstanding any other
Page 22, Line 16provision of this section to the contrary, money in the ARPA account as
Page 22, Line 17a result of fund savings and federal matching dollars must be used in
Page 22, Line 18accordance with section 9817 of the federal "American Rescue Plan Act
Page 22, Line 19of 2021", Pub.L. 117-2, as amended, referred to in this section as
Page 22, Line 20"ARPA", to implement or supplement the implementation of home- and
Page 22, Line 21community-based services under the medical assistance program pursuant
Page 22, Line 22to the provisions of part 18 of article 6 of this title 25.5.
Page 23, Line 1(II) (C) If the fund savings due to the enhanced federal match
Page 23, Line 2under ARPA is less than the amount transferred to the ARPA account
Page 23, Line 3under subsection (5)(c)(II)(A) of this section, then the state department
Page 23, Line 4shall notify the state treasurer of the amount by which the transfer
Page 23, Line 5exceeds the savings. The state treasurer shall transfer this amount from the ARPA account to the hospital provider fee cash fund.
Page 23, Line 6(III) The state treasurer shall credit all interest and income derived
Page 23, Line 7from the money in the ARPA account to the hospital provider fee cash fund.
Page 23, Line 8(V) Money in the ARPA account remains in the ARPA account
Page 23, Line 9until the end of the spending period authorized under ARPA, at which
Page 23, Line 10time money remaining in the ARPA account becomes part of the hospital provider fee cash fund.
Page 23, Line 11(5.5) Healthcare affordability and sustainability nursing
Page 23, Line 12facility provider fee cash fund. (a) All healthcare affordability
Page 23, Line 13and sustainability nursing provider fees collected pursuant to
Page 23, Line 14this section by the enterprise must be transmitted to the state
Page 23, Line 15treasurer, who shall credit the fee to the healthcare
Page 23, Line 16affordability and sustainability nursing facility provider fee
Page 23, Line 17cash fund, which fund is created. The state treasurer shall
Page 23, Line 18credit all interest and income derived from the deposit and
Page 23, Line 19investment of money in the nursing facility provider fee cash
Page 23, Line 20fund to the nursing facility provider fee cash fund. The state
Page 23, Line 21treasurer shall invest any money in the nursing facility
Page 23, Line 22provider fee cash fund not expended for the purposes specified in
Page 23, Line 23subsections (4.5)(a) and (5.5)(b) of this section as provided by law.
Page 23, Line 24Money in the nursing facility provider fee cash fund shall not
Page 24, Line 1be transferred to any other fund and shall not be used for any
Page 24, Line 2purpose other than the purposes specified in this subsection (5.5) and in subsection (4.5)(a) of this section.
Page 24, Line 3(b) All money in the nursing facility provider fee cash
Page 24, Line 4fund is subject to federal matching as authorized under federal
Page 24, Line 5law and, subject to annual appropriation by the general
Page 24, Line 6assembly, must be expended by the enterprise for the following purposes:
Page 24, Line 7(I) (A) To pay the administrative costs of implementing this subsection (5.5) and subsection (4.5) of this section;
Page 24, Line 8(B) To satisfy settlements or judgments resulting from nursing facility provider reimbursement appeals; and
Page 24, Line 9(C) To pay a nursing facility provider a supplemental
Page 24, Line 10medicaid payment for care and services rendered to medicaid
Page 24, Line 11residents to offset payment of the nursing facility provider fee.
Page 24, Line 12The enterprise, in consultation with the state department, shall
Page 24, Line 13compute this payment annually, beginning on May 1, 2025, and each July 1 thereafter.
Page 24, Line 14(II) After the payment of the amounts described in
Page 24, Line 15subsection (5.5)(b)(I) of this section, to pay the supplemental
Page 24, Line 16medicaid payments for acuity or case-mix of residents
Page 24, Line 17established under section 25.5-6-202 (2), prior to its repeal on
Page 24, Line 18July 1, 2026, or as provided in the rules adopted by the state
Page 24, Line 19board pursuant to section 25.5-6-202 (10) and (14)(a), in
Page 24, Line 20consultation with the enterprise as provided in subsection(7)(g)(IV) of this section;
Page 24, Line 21(III) After the payment of the amounts described in
Page 25, Line 1subsections (5.5)(b)(I) and (5.5)(b)(II) of this section, to pay
Page 25, Line 2supplemental medicaid payments based upon performance to
Page 25, Line 3those nursing facility providers that provide services that
Page 25, Line 4result in better care and higher quality of life for their
Page 25, Line 5residents. The enterprise, in consultation with the state board,
Page 25, Line 6shall determine the payment amount based upon performance
Page 25, Line 7measures established in rules adopted by the state board in the
Page 25, Line 8domains of quality of life, quality of care, and facility
Page 25, Line 9management. During each state fiscal year, the enterprise may
Page 25, Line 10discontinue the supplemental medicaid payment established
Page 25, Line 11pursuant to this subsection (5.5)(b)(III) to any nursing facility
Page 25, Line 12provider that fails to comply with the established performance
Page 25, Line 13measures during the state fiscal year, and the enterprise may
Page 25, Line 14initiate the supplemental medicaid payment established pursuant
Page 25, Line 15to this subsection (5.5)(b)(III) to any nursing facility provider
Page 25, Line 16that comes into compliance with the established performance measures during the state fiscal year.
Page 25, Line 17(IV) (A) After the payment of the amounts described in
Page 25, Line 18subsections (5.5)(b)(I) to (5.5)(b)(III) of this section, to pay the
Page 25, Line 19supplemental medicaid payments to nursing facility providers
Page 25, Line 20that serve residents who have moderate to very severe mental
Page 25, Line 21health conditions, dementia diseases and related disabilities, or
Page 25, Line 22acquired brain injury. The enterprise, in consultation with the
Page 25, Line 23state department, shall compute this payment annually, beginning on May 1, 2025, and each July 1 thereafter.
Page 25, Line 24(B) If the enterprise determines, in consultation with the
Page 25, Line 25state department, that the case-mix reimbursement described in
Page 26, Line 1subsection (5.5)(b)(II) of this section includes a factor for
Page 26, Line 2nursing facility providers that serve residents with severe
Page 26, Line 3dementia diseases and related disabilities or acquired brain
Page 26, Line 4injury, the enterprise may eliminate this supplemental medicaid
Page 26, Line 5payment to those nursing facility providers that serve residents
Page 26, Line 6with severe dementia diseases and related disabilities or acquired brain injury.
Page 26, Line 7(V) After the payment of the amounts described in
Page 26, Line 8subsections (5.5)(b)(I) to (5.5)(b)(IV) of this section, to pay the
Page 26, Line 9supplemental medicaid payments for the amount of the
Page 26, Line 10aggregate statewide average per diem rate of patient payment
Page 26, Line 11established under section 25.5-6-202 (9), prior to its repeal on
Page 26, Line 12July 1, 2026, or as provided in the rules adopted by the state
Page 26, Line 13board pursuant to section 25.5-6-202 (10) and (14)(a), in
Page 26, Line 14consultation with the enterprise as provided in subsection(7)(g)(IV) of this section.
Page 26, Line 15(5.7) Healthcare affordability and sustainability intermediate
Page 26, Line 16care facility fee cash fund. (a) All healthcare affordability and
Page 26, Line 17sustainability intermediate care facility fees collected
Page 26, Line 18pursuant to this section by the enterprise must be transmitted
Page 26, Line 19to the state treasurer, who shall credit the fee to the
Page 26, Line 20healthcare affordability and sustainability intermediate care
Page 26, Line 21facility fee cash fund, which fund is created. The state
Page 26, Line 22treasurer shall credit all interest and income derived from the
Page 26, Line 23deposit and investment of money in the intermediate care
Page 26, Line 24facility fee cash fund to the intermediate care facility cash
Page 26, Line 25fund. The state treasurer shall invest any money in the
Page 27, Line 1intermediate care facility fee cash fund not expended for the
Page 27, Line 2purposes specified in subsections (4.7)(a) and (5.7)(b) of this
Page 27, Line 3section as provided by law. Money in the intermediate care
Page 27, Line 4facility fee cash fund shall not be transferred to any other
Page 27, Line 5fund and shall not be used for any purpose other than the
Page 27, Line 6purposes specified in this subsection (5.7) and in subsection (4.7)(a) of this section.
Page 27, Line 7(b) All money in the intermediate care facility fee cash
Page 27, Line 8fund is subject to federal matching as authorized under federal
Page 27, Line 9law and, subject to annual appropriation by the general
Page 27, Line 10assembly, must be expended by the enterprise for the following purposes:
Page 27, Line 11(I) To pay the administrative costs of implementing this subsection (5.7) and subsection (4.7) of this section; and
Page 27, Line 12(II) To supplement reimbursements to intermediate care
Page 27, Line 13facilities for individuals with intellectual disabilities as
Page 27, Line 14provided in section 25.5-6-204. The enterprise, in consultation
Page 27, Line 15with the state department, shall compute this payment annually, beginning on May 1, 2025, and each July 1 thereafter.
Page 27, Line 16(6) Appropriations. (a) (I) Except as otherwise provided in
Page 27, Line 17subsection (6)(b)(I.5) or (6)(b)(I.7) of this section, the healthcare
Page 27, Line 18affordability and sustainability
Page 27, Line 19not supplant, general fund appropriations to support hospital
Page 27, Line 20reimbursements. General fund appropriations for hospital reimbursements
Page 27, Line 21shall be maintained at the level of appropriations in the medical services
Page 27, Line 22premium line item made for the fiscal year commencing July 1, 2008;
Page 27, Line 23except that general fund appropriations for hospital reimbursements may
Page 28, Line 1be reduced if an index of appropriations to other providers shows that
Page 28, Line 2general fund appropriations are reduced for other providers. If the index
Page 28, Line 3shows that general fund appropriations are reduced for other providers,
Page 28, Line 4the general fund appropriations for hospital reimbursements shall not be
Page 28, Line 5reduced by a greater percentage than the reductions of appropriations for the other providers as shown by the index.
Page 28, Line 6(IV) Except as otherwise provided in subsection (5.5)(b)(V)
Page 28, Line 7of this section, the nursing facility provider fee is to supplement,
Page 28, Line 8not supplant, general fund appropriations to support nursing facility provider reimbursements.
Page 28, Line 9(V) Except as otherwise provided in subsection (5.7)(b)(II)
Page 28, Line 10of this section, the intermediate care facility fee is to
Page 28, Line 11supplement, not supplant, general fund appropriations to support intermediate care facility reimbursements.
Page 28, Line 12(b) If the revenue from the healthcare affordability and
Page 28, Line 13sustainability
Page 28, Line 14(II) The hospital provider reimbursement and quality incentive
Page 28, Line 15payment increases described in subsections (5)(b)(I) to (5)(b)(III) of this
Page 28, Line 16section and the costs described in subsection (5)(b)(VI) of this section
Page 28, Line 17shall be fully funded using revenue from the healthcare affordability and
Page 28, Line 18sustainability
Page 28, Line 19(III) (A) If the state board promulgates rules that expand eligibility
Page 28, Line 20for medical assistance to be paid for pursuant to subsection (5)(b)(IV) of
Page 28, Line 21this section, and the state department thereafter notifies the enterprise
Page 28, Line 22board that the revenue available from the healthcare affordability and
Page 29, Line 1sustainability
Page 29, Line 2not be sufficient to pay for all or part of the expanded eligibility, the
Page 29, Line 3enterprise board shall recommend to the state board reductions in medical
Page 29, Line 4benefits or eligibility so that the revenue will be sufficient to pay for all
Page 29, Line 5of the reduced benefits or eligibility. After receiving the
Page 29, Line 6recommendations of the enterprise board, the state board shall adopt rules
Page 29, Line 7providing for reduced benefits or reduced eligibility for which the
Page 29, Line 8revenue will be sufficient and shall forward any adopted rules to the joint
Page 29, Line 9budget committee. Notwithstanding the provisions of section 24-4-103
Page 29, Line 10(8) and (12), following the adoption of rules pursuant to this subsection
Page 29, Line 11(6)(b)(III)(A), the state board shall not submit the rules to the attorney
Page 29, Line 12general and shall not file the rules with the secretary of state until the joint
Page 29, Line 13budget committee approves the rules pursuant to subsection (6)(b)(III)(B) of this section.
Page 29, Line 14(B) The joint budget committee shall promptly consider any rules
Page 29, Line 15adopted by the state board pursuant to subsection (6)(b)(III)(A) of this
Page 29, Line 16section. The joint budget committee shall promptly notify the state
Page 29, Line 17department, the state board, and the enterprise board of any action on the
Page 29, Line 18rules. If the joint budget committee does not approve the rules, the joint
Page 29, Line 19budget committee shall recommend a reduction in benefits or eligibility
Page 29, Line 20so that the revenue from the healthcare affordability and sustainability
Page 29, Line 21hospital provider fee and the matching federal funds will be sufficient
Page 29, Line 22to pay for the reduced benefits or eligibility. After approving the rules
Page 29, Line 23pursuant to this subsection (6)(b)(III)(B), the joint budget committee shall
Page 29, Line 24request that the committee on legal services, created pursuant to section
Page 29, Line 252-3-501, extend the rules as provided for in section 24-4-103 (8) unless
Page 29, Line 26the committee on legal services finds after review that the rules do not conform with section 24-4-103 (8)(a).
Page 30, Line 1(b.5) If the revenue from the nursing facility provider fee
Page 30, Line 2is insufficient to fully fund all of the purposes described in subsection (5.5)(b) of this section:
Page 30, Line 3(I) The general assembly is not obligated to appropriate general fund revenues to fund such purposes; and
Page 30, Line 4(II) Subject to the priority of the uses for the nursing
Page 30, Line 5facility provider fee as provided in subsection (5.5)(b) of this
Page 30, Line 6section, the enterprise, in consultation with the state
Page 30, Line 7department, may suspend or reduce any supplemental medicaid payment.
Page 30, Line 8(c) Notwithstanding any other provision of this section, if, after
Page 30, Line 9receipt of authorization to receive federal matching funds for money in
Page 30, Line 10the hospital provider fee cash fund, the authorization is withdrawn or
Page 30, Line 11changed so that federal matching funds are no longer available, the
Page 30, Line 12enterprise shall cease collecting the healthcare affordability and
Page 30, Line 13sustainability
Page 30, Line 14money received by the hospital provider fee cash fund that is not subject to federal matching funds.
Page 30, Line 15(c.5) Notwithstanding any other provision of this section,
Page 30, Line 16if, after receipt of authorization to receive federal matching
Page 30, Line 17funds for money in the nursing facility provider fee cash fund,
Page 30, Line 18the authorization is withdrawn or changed so that federal
Page 30, Line 19matching funds are no longer available, the enterprise shall
Page 30, Line 20cease collecting the nursing facility provider fee and shall
Page 30, Line 21repay to the nursing facility providers any money received in
Page 30, Line 22the nursing facility provider fee cash fund that is not subject to federal matching funds.
Page 31, Line 1(c.7) Notwithstanding any other provision of this section,
Page 31, Line 2if, after receipt of authorization to receive federal matching
Page 31, Line 3funds for money in the intermediate care facility fee cash fund,
Page 31, Line 4the authorization is withdrawn or changed so that federal
Page 31, Line 5matching funds are no longer available, the enterprise shall
Page 31, Line 6cease collecting the intermediate care facility fee and shall
Page 31, Line 7repay to the intermediate care facilities any money received in
Page 31, Line 8the intermediate care facility fee cash fund that is not subject to federal matching funds.
Page 31, Line 9(7) Colorado healthcare affordability and sustainability
Page 31, Line 10enterprise board. (b) Members of the enterprise board serve without
Page 31, Line 11compensation but must be reimbursed from money in the hospital
Page 31, Line 12provider fee cash fund for actual and necessary expenses incurred in the performance of their duties pursuant to this section.
Page 31, Line 13(d) The enterprise board has, at a minimum, the following duties:
Page 31, Line 14(I) To determine the timing and method by which the enterprise
Page 31, Line 15assesses the healthcare affordability and sustainability
Page 31, Line 16(II) If requested by the health and human services committee of
Page 31, Line 17the senate or the publiccare
Page 31, Line 18house of representatives, or any successor committees, to consult with the
Page 31, Line 19committees on any legislation that may impact the healthcare affordability
Page 31, Line 20and sustainability feehospital
Page 31, Line 21(III) To determine changes in the healthcare affordability and
Page 31, Line 22sustainability
Page 32, Line 1hospitals benefitting from the uses of the healthcare affordability and
Page 32, Line 2sustainability
Page 32, Line 3section or that minimize the number of hospitals that suffer losses as a
Page 32, Line 4result of paying the healthcare affordability and sustainability
Page 32, Line 5(IX) To monitor the impact of the healthcare affordability and
Page 32, Line 6sustainability
Page 32, Line 7fee, and the intermediate care facility fee on the broader health-care marketplace;
Page 32, Line 8(X) To establish requirements for the reports that hospitals must
Page 32, Line 9submit to the enterprise to allow the enterprise to calculate the amount of
Page 32, Line 10the healthcare affordability and sustainability
Page 32, Line 11(e) On or before January 15, 2018, and on or before January 15
Page 32, Line 12each year thereafter, the enterprise board shall submit a written report to
Page 32, Line 13the health and human services committee of the senate and the public
Page 32, Line 14health care
Page 32, Line 15or any successor committees, the joint budget committee of the general
Page 32, Line 16assembly, the governor, and the state board. The report shall include, but need not be limited to:
Page 32, Line 17(II) A description of the formula for how the healthcare
Page 32, Line 18affordability and sustainability
Page 32, Line 19the process by which the healthcare affordability and sustainability
Page 32, Line 20(II.5) A description of the formula for how the nursing
Page 32, Line 21facility provider fee is calculated and the process by which the
Page 32, Line 22fee is assessed and collected;
Page 33, Line 1(II.7) A description of the formula for how the
Page 33, Line 2intermediate care facility fee is calculated and the process by which the fee is assessed and collected;
Page 33, Line 3(III) An itemization of the total amount of the healthcare
Page 33, Line 4affordability and sustainability
Page 33, Line 5hospital and any projected revenue that each hospital is expected to receive due to:
Page 33, Line 6(III.5) An itemization of the total amount of the nursing
Page 33, Line 7facility provider fee paid by each nursing facility provider and
Page 33, Line 8any projected revenue that each nursing facility provider is
Page 33, Line 9expected to receive due to increased reimbursements and
Page 33, Line 10supplemental payments made pursuant to subsection (5.5)(b) of this section;
Page 33, Line 11(III.7) An itemization of the total amount of the
Page 33, Line 12intermediate care facility fee paid by each intermediate care
Page 33, Line 13facility for individuals with intellectual disabilities and any
Page 33, Line 14projected revenue that each intermediate care facility is
Page 33, Line 15expected to receive due to increased reimbursements made pursuant to subsection (5.7)(b) of this section;
Page 33, Line 16(IV) An itemization of the costs incurred by the enterprise in
Page 33, Line 17implementing and administering the healthcare affordability and
Page 33, Line 18sustainability
Page 33, Line 19(g) (I) The facility provider fee enterprise support board
Page 33, Line 20is created within the enterprise for the purpose of supporting the
Page 33, Line 21enterprise board with the implementation of the nursing facility
Page 33, Line 22provider fee and the intermediate care facility fee. The facility
Page 34, Line 1provider fee enterprise support board consists of eight members
Page 34, Line 2appointed by the governor, with the advice and consent of the senate, as follows:
Page 34, Line 3(A) Two members who are representatives of nursing facility associations;
Page 34, Line 4(B) Two members who are representatives of nursing
Page 34, Line 5facilities, with one member representing a rural nursing facility;
Page 34, Line 6(C) One member who is a resident of a long-term care
Page 34, Line 7facility or a consumer of long-term care services, or a family member or guardian representing such resident or consumer;
Page 34, Line 8(D) One employee of the state department;
Page 34, Line 9(E) One employee of the department of human services created in section 24-1-120; and
Page 34, Line 10(F) One employee of the department of public health and environment created in section 25-1-102.
Page 34, Line 11(II) (A) Members of the facility provider fee enterprise
Page 34, Line 12support board serve at the pleasure of the governor. All terms
Page 34, Line 13are for four years. A member who is appointed to fill a vacancy
Page 34, Line 14shall serve the remainder of the unexpired term of the former member.
Page 34, Line 15(B) The governor shall make the initial appointments to
Page 34, Line 16the facility provider fee enterprise support board as soon as practical following May 1, 2025.
Page 34, Line 17(III) The facility provider fee enterprise support board shall elect a chair and a vice-chair from among its members.
Page 34, Line 18(IV) The facility provider fee enterprise support board
Page 35, Line 1shall fulfill, at a minimum, the following duties on behalf of the enterprise:
Page 35, Line 2(A) To determine the timing and method by which the
Page 35, Line 3enterprise assesses the nursing facility provider fee and the intermediate care facility fee and the amounts of the fees;
Page 35, Line 4(B) To determine changes in the nursing facility provider
Page 35, Line 5fee that increase the number of nursing facility providers
Page 35, Line 6benefitting from the uses of the fee described in subsection
Page 35, Line 7(5.5)(b) of this section or that minimize the number of nursing
Page 35, Line 8facility providers that suffer losses as a result of paying the nursing facility provider fee;
Page 35, Line 9(C) To determine changes in the intermediate care facility
Page 35, Line 10fee that increase the number of intermediate care facilities for
Page 35, Line 11individuals with intellectual disabilities that benefit from the
Page 35, Line 12uses of the fee described in subsection (5.7)(b) of this section or
Page 35, Line 13that minimize the number of intermediate care facilities for
Page 35, Line 14individuals with intellectual disabilities that suffer losses as a result of paying the nursing facility provider fee;
Page 35, Line 15(D) To consult with the state board on the rules
Page 35, Line 16regarding payments to nursing facility providers that it adopts pursuant to section 25.5-6-202 (10) and (14)(a);
Page 35, Line 17(E) To consult with the state board and the state
Page 35, Line 18department on the rules, price schedules, and allowances
Page 35, Line 19regarding reimbursement and payments to intermediate care facilities that they adopt pursuant to section 25.5-6-204;
Page 35, Line 20(F) To establish requirements for the reports that
Page 35, Line 21nursing facility providers must submit to the enterprise to
Page 36, Line 1allow the enterprise to calculate the amount of the nursing facility provider fee; and
Page 36, Line 2(G) To establish requirements for the reports that
Page 36, Line 3intermediate care facilities must submit to the enterprise to
Page 36, Line 4allow the enterprise to calculate the amount of the intermediate care facility fee.
Page 36, Line 5(V) Members of the facility provider fee enterprise
Page 36, Line 6support board serve without compensation but must be
Page 36, Line 7reimbursed from money in the nursing facility provider fee cash
Page 36, Line 8fund or the intermediate care facility fee cash fund for actual
Page 36, Line 9and necessary expenses incurred in the performance of their duties pursuant to this section.
Page 36, Line 10(9) Definitions.As used in this section, unless the context otherwise requires:
Page 36, Line 11(a) "Case-mix" has the same meaning as set forth in section 25.5-6-201 (8).
Page 36, Line 12(b) "Case-mix reimbursement" has the same meaning as set forth in section 25.5-6-201 (12).
Page 36, Line 13(c) "Colorado healthcare affordability and
Page 36, Line 14sustainability enterprise" or "enterprise" means the enterprise created in subsection (3) of this section.
Page 36, Line 15(d) "Facility provider fee enterprise support board" means
Page 36, Line 16the facility provider fee enterprise support board created in subsection (7)(g) of this section.
Page 36, Line 17(e) "Healthcare affordability and sustainability hospital
Page 36, Line 18provider fee" or "hospital provider fee" means the healthcare
Page 36, Line 19affordability and sustainability hospital provider fee charged and collected as authorized by subsection (4) of this section.
Page 37, Line 1(f) "Healthcare affordability and sustainability hospital
Page 37, Line 2provider fee cash fund" or "hospital provider fee cash fund"
Page 37, Line 3means the healthcare affordability and sustainability hospital provider fee cash fund created in subsection (5) of this section.
Page 37, Line 4(g) "Healthcare affordability and sustainability
Page 37, Line 5intermediate care facility fee" or "intermediate care facility
Page 37, Line 6fee" means the healthcare affordability and sustainability
Page 37, Line 7intermediate care facility fee for intermediate care facilities
Page 37, Line 8for individuals with intellectual disabilities charged and collected as authorized by subsection (4.7) of this section.
Page 37, Line 9(h) "Healthcare affordability and sustainability
Page 37, Line 10intermediate care facility fee cash fund" or "intermediate care
Page 37, Line 11facility fee cash fund" means the healthcare affordability and
Page 37, Line 12sustainability intermediate care facility fee cash fund created in subsection (5.7) of this section.
Page 37, Line 13(i) "Healthcare affordability and sustainability nursing
Page 37, Line 14facility provider fee" or "nursing facility provider fee" means
Page 37, Line 15the healthcare affordability and sustainability nursing facility
Page 37, Line 16provider fee charged and collected as authorized by subsection (4.5) of this section.
Page 37, Line 17(j) "Healthcare affordability and sustainability nursing
Page 37, Line 18facility provider fee cash fund" or "nursing facility provider fee
Page 37, Line 19cash fund" means the healthcare affordability and
Page 37, Line 20sustainability nursing facility provider fee cash fund created in subsection (5.5) of this section.
Page 37, Line 21(k) "Hospital" means a licensed or certified hospital.
Page 38, Line 1(l) "Nursing facility provider" has the same meaning as set forth in section 25.5-6-201 (25).
Page 38, Line 2(m) "State medical assistance program" means the
Page 38, Line 3program described in this article 4 and articles 5 and 6 of this title 25.5.
Page 38, Line 4(n) "Statewide average per diem rate" has the same meaning as set forth in section 25.5-6-201 (35).
Page 38, Line 5(o) "Supplemental medicaid payment" has the same meaning as set forth in section 25.5-6-201 (36).
Page 38, Line 6SECTION 2. In Colorado Revised Statutes, 25.5-4-402.4, amend
Page 38, Line 7(2) introductory portion and (2)(d) introductory portion; and amend as
Page 38, Line 8they will become effective July 1, 2025, (2)(d)(I), (4)(a) introductory portion, and (4)(g)(I) as follows:
Page 38, Line 925.5-4-402.4. Healthcare affordability and sustainability
Page 38, Line 10hospital provider fee - healthcare affordability and sustainability
Page 38, Line 11nursing facility provider fee - healthcare affordability and
Page 38, Line 12sustainability intermediate care facility fee - Colorado healthcare
Page 38, Line 13affordability and sustainability enterprise - federal waiver - funds
Page 38, Line 14created - reports - rules - legislative declaration - repeal.
Page 38, Line 15(2) Legislative declaration. The general assembly hereby
Page 38, Line 16(d) The Colorado healthcare affordability and sustainability
Page 38, Line 17enterprise provides business services to hospitals when, in exchange for
Page 38, Line 18payment of healthcare affordability and sustainability hospital provider fees by hospitals, it:
Page 38, Line 19(I) Obtains federal matching money and returns both the
Page 38, Line 20healthcare affordability and sustainability
Page 39, Line 1federal matching money to hospitals to increase reimbursement rates to
Page 39, Line 2hospitals for providing medical care under the state medical assistance
Page 39, Line 3program, including disproportionate share hospital payments pursuant to
Page 39, Line 442 U.S.C. sec. 1396r-4, and to increase the number of individuals covered by public medical assistance; and
Page 39, Line 5(4) Healthcare affordability and sustainability fee. (a) For the
Page 39, Line 6fiscal year commencing July 1, 2017, and for each fiscal year thereafter,
Page 39, Line 7the enterprise is authorized to charge and collect a healthcare affordability
Page 39, Line 8and sustainability hospital provider fee, as described in 42 CFR 433.68
Page 39, Line 9(b), on outpatient and inpatient services provided by all licensed or
Page 39, Line 10certified hospitals referred to in this section as "hospitals",
Page 39, Line 11of obtaining federal financial participation under the state medical
Page 39, Line 12assistance program as described in this article 4 and articles 5 and 6 of
Page 39, Line 13this title 25.5, referred to in this section as the "state medical assistance
Page 39, Line 14program",
Page 39, Line 15to 42 U.S.C. sec. 1396r-4. If the amount of healthcare affordability and
Page 39, Line 16sustainability
Page 39, Line 17federal net patient revenue-based limit on the amount of such fee revenue
Page 39, Line 18that may be collected, requiring repayment to the federal government of
Page 39, Line 19excess federal matching money received, hospitals that received such
Page 39, Line 20excess federal matching money are responsible for repaying the excess
Page 39, Line 21federal money and any associated federal penalties to the federal
Page 39, Line 22government. The enterprise shall use the healthcare affordability and sustainability
Page 39, Line 23(g) (I) The state board shall promulgate any rules pursuant to the
Page 39, Line 24"State Administrative Procedure Act", article 4 of title 24, necessary for
Page 39, Line 25the administration and implementation of this section. Prior to submitting
Page 40, Line 1any proposed rules concerning the administration or implementation of
Page 40, Line 2the healthcare affordability and sustainability
Page 40, Line 3the state board, the enterprise shall consult with the state board on the proposed rules as specified in subsection (7)(d) of this section.
Page 40, Line 4SECTION 3. In Colorado Revised Statutes, 25.5-5-103, amend (1)(b) as follows:
Page 40, Line 525.5-5-103. Mandated programs with special state provisions
Page 40, Line 6- rules. (1) This section specifies programs developed by Colorado to meet federal mandates. These programs include but are not limited to:
Page 40, Line 7(b) Special provisions relating to nursing facilities, as specified in
Page 40, Line 8sections 25.5-6-201 to 25.5-6-203, 25.5-6-205, and 25.5-6-206
Page 40, Line 925.5-4-402.4 (4.5) and (5.5), 25.5-6-201, 25.5-6-202, 25.5-6-205, and 25.5-6-206;
Page 40, Line 10SECTION 4. In Colorado Revised Statutes, 25.5-6-202, amend
Page 40, Line 11(9)(b)(I) introductory portion, (9)(b)(II), and (9)(b)(VI); and repeal (5), (6), (7), (9)(b.3), and (9)(d) as follows:
Page 40, Line 1225.5-6-202. Providers - nursing facility provider
Page 40, Line 13reimbursement - exemption - rules - repeal. (5) Subject to available
Page 40, Line 14appropriations and the priority of the uses of the provider fees as
Page 40, Line 15established in section 25.5-6-203 (2)(b), in addition to the reimbursement
Page 40, Line 16rate components paid pursuant to subsections (1) to (4) of this section, the
Page 40, Line 17state department shall make a supplemental medicaid payment based
Page 40, Line 18upon performance to those nursing facility providers that provide services
Page 40, Line 19that result in better care and higher quality of life for their residents. The
Page 40, Line 20state department shall determine the payment amount based upon
Page 40, Line 21performance measures established in rules adopted by the state board in
Page 40, Line 22the domains of quality of life, quality of care, and facility management.
Page 41, Line 1Beginning July 1, 2024, the payment must not be less than twelve percent
Page 41, Line 2of total provider fee payments and must be adjusted for fiscal years
Page 41, Line 32024-25 and 2025-26. No later than July 1, 2026, the payment must not
Page 41, Line 4be less than fifteen percent of total provider fee payments and must be
Page 41, Line 5annually adjusted thereafter. During each state fiscal year, the state
Page 41, Line 6department may discontinue the supplemental medicaid payment
Page 41, Line 7established pursuant to this subsection (5) to any nursing facility provider
Page 41, Line 8that fails to comply with the established performance measures during the
Page 41, Line 9state fiscal year, and the state department may initiate the supplemental
Page 41, Line 10medicaid payment established pursuant to this subsection (5) to any
Page 41, Line 11provider that comes into compliance with the established performance measures during the state fiscal year.
Page 41, Line 12(6) Subject to available appropriations and the priority of the uses
Page 41, Line 13of the provider fees as established in section 25.5-6-203 (2)(b), in
Page 41, Line 14addition to the reimbursement rate components paid pursuant to
Page 41, Line 15subsections (1) to (5) of this section, the state department shall make a
Page 41, Line 16supplemental medicaid payment to nursing facility providers that serve residents:
Page 41, Line 17(a) Who have severe mental health conditions that are classified
Page 41, Line 18at a level II by the medicaid program's preadmission screening and
Page 41, Line 19resident review assessment tool. The state department shall compute this
Page 41, Line 20payment annually as of July 1, 2009, and each July 1 thereafter, and it
Page 41, Line 21must not be less than two percent of the statewide average per diem rate
Page 41, Line 22for the combined rate components determined pursuant to subsections (1)
Page 41, Line 23to (4) of this section. Beginning July 1, 2023, the state department shall
Page 41, Line 24annually adjust the rate to ensure access to care for residents who have
Page 41, Line 25severe mental health conditions.
Page 42, Line 1(b) With severe dementia diseases and related disabilities or
Page 42, Line 2acquired brain injury. The state department shall calculate the payment
Page 42, Line 3based upon the resident's cognitive assessment established in rules
Page 42, Line 4adopted by the state board. The state department shall compute this
Page 42, Line 5payment annually as of July 1, 2009, and each July 1 thereafter, and it
Page 42, Line 6must not be less than one percent of the statewide average per diem rate
Page 42, Line 7for the combined rate components determined pursuant to subsections (1)
Page 42, Line 8to (4) of this section. Beginning July 1, 2023, the state department shall
Page 42, Line 9annually adjust the rate to ensure access to care for residents with severe dementia diseases and related disabilities or acquired brain injury.
Page 42, Line 10(7) Subject to available moneys and the priority of the uses of the
Page 42, Line 11provider fees as established in section 25.5-6-203 (2)(b), in addition to the
Page 42, Line 12reimbursement rate components paid pursuant to subsections (1) to (6) of
Page 42, Line 13this section, the state department shall pay a nursing facility provider a
Page 42, Line 14supplemental medicaid payment for care and services rendered to
Page 42, Line 15medicaid residents to offset payment of the provider fee assessed under
Page 42, Line 16the provisions of section 25.5-6-203. The state department shall compute this payment annually, as of July 1, 2009, and each July 1 thereafter.
Page 42, Line 17(9) (b) (I) Except for changes in the number of patient days, the
Page 42, Line 18state department shall establish the general fund share of the aggregate
Page 42, Line 19statewide average of the per diem rate net of patient payment pursuant to
Page 42, Line 20subsections (1) to (4) of this section. The state's share of the
Page 42, Line 21reimbursement rate components pursuant to subsections (1) to (4) of this
Page 42, Line 22section may be funded through the provider fee assessed pursuant to
Page 42, Line 23section 25.5-6-203
Page 42, Line 24funds. Any provider fee used as the state's share and all federal funds
Page 42, Line 25must be excluded from the calculation of the general fund share. For the
Page 43, Line 1fiscal year commencing July 1, 2009, and for each fiscal year thereafter,
Page 43, Line 2the state department shall calculate the general fund share of the
Page 43, Line 3aggregate statewide average per diem rate net of patient payment pursuant
Page 43, Line 4to subsections (1) to (4) of this section using the rates that were effective on July 1 of that fiscal year; except that:
Page 43, Line 5(II) If the aggregate statewide average per diem rate net of patient
Page 43, Line 6payment pursuant to subsections (1) to (4) of this section exceeds the
Page 43, Line 7general fund share, the amount of the average statewide per diem rate that
Page 43, Line 8exceeds the general fund share shall
Page 43, Line 9medicaid payment using the provider fee established under section
Page 43, Line 1025.5-6-203
Page 43, Line 11of the provider fee established under section 25.5-6-203 (2)(b)
Page 43, Line 1225.5-4-402.4 (5.5)(b), if the provider fee is insufficient to fully fund the
Page 43, Line 13supplemental medicaid payment, the supplemental medicaid payment shall
Page 43, Line 14(VI) Notwithstanding any other provision of law, for the fiscal
Page 43, Line 15year commencing July 1, 2013, and each fiscal year thereafter, the general
Page 43, Line 16fund portion of the per diem rate pursuant to subsections (1) to (4) of this
Page 43, Line 17section shall be reduced by one and one-half percent. The state
Page 43, Line 18department may, but is not required to, increase the supplemental
Page 43, Line 19medicaid payment pursuant to subparagraph (II) of this paragraph (b)
Page 43, Line 20subsection (9)(b)(II) of this section due to this reduction. except that
Page 43, Line 21the provider fee shall not exceed the amount specified in section 25.5-6-203 (1)(a)(II).
Page 43, Line 22(b.3) (I) For the fiscal year commencing July 1, 2009, and for each
Page 43, Line 23fiscal year thereafter, if the provider fee established under section
Page 43, Line 2425.5-6-203 is insufficient to fully fund the supplemental medicaid
Page 44, Line 1payments established under subsections (5) to (7) of this section, subject
Page 44, Line 2to the priority of the uses of the provider fee established pursuant to
Page 44, Line 3section 25.5-6-203 (2)(b), the state department may suspend or reduce the
Page 44, Line 4supplemental medicaid payment subject to the uses of the provider fee established under section 25.5-6-203.
Page 44, Line 5(II) If it is determined by the state department that the case-mix
Page 44, Line 6reimbursement includes a factor for nursing facility providers that serve
Page 44, Line 7residents with severe dementia diseases and related disabilities or
Page 44, Line 8acquired brain injury, the state department may eliminate the
Page 44, Line 9supplemental medicaid payment to those providers that serve residents
Page 44, Line 10with severe dementia diseases and related disabilities or acquired brain injury.
Page 44, Line 11(d) The reimbursement rate components pursuant to subsections
Page 44, Line 12(5) to (7) of this section shall be funded entirely through the provider fee
Page 44, Line 13assessed pursuant to the provisions of section 25.5-6-203 and any
Page 44, Line 14associated federal funds. No general fund moneys shall be used to pay for
Page 44, Line 15the reimbursement rate components established pursuant to subsections (5) to (7) of this section.
Page 44, Line 16SECTION 5. In Colorado Revised Statutes, 25.5-6-203, repeal (1); and add (2)(a.5) and (3) as follows:
Page 44, Line 1725.5-6-203. Nursing facilities - provider fees - federal waiver
Page 44, Line 18- fund created - rules - repeal. (1) (a) (I) Beginning with the fiscal year
Page 44, Line 19commencing July 1, 2008, and each fiscal year thereafter, the state
Page 44, Line 20department shall charge and collect provider fees on health-care items or
Page 44, Line 21services provided by nursing facility providers for the purpose of
Page 44, Line 22obtaining federal financial participation under the state's medical
Page 44, Line 23assistance program as described in articles 4 to 6 of this title. As specified
Page 45, Line 1by the priority of the uses of the provider fee in paragraph (b) of
Page 45, Line 2subsection (2) of this section, the provider fees shall be used to sustain or
Page 45, Line 3increase reimbursement for providing medical care under the state's medical assistance program for nursing facility providers.
Page 45, Line 4(II) For the fiscal years commencing July 1, 2009, and July 1,
Page 45, Line 52010, the provider fee shall not exceed seven dollars and fifty cents per
Page 45, Line 6nonmedicare-resident day. For the fiscal year commencing July 1, 2011,
Page 45, Line 7and each fiscal year thereafter, the provider fee shall not exceed twelve
Page 45, Line 8dollars per nonmedicare-resident day plus inflation based on the national
Page 45, Line 9skilled nursing facility market basket index as determined by the secretary
Page 45, Line 10of the department of health and human services pursuant to 42 U.S.C. sec. 1395yy (e)(5) or any successor index.
Page 45, Line 11(III) In calculating the amount of the provider fee portion of the
Page 45, Line 12supplemental medicaid payments established under section 25.5-6-202
Page 45, Line 13(5), the state department may include an additional amount of up to five
Page 45, Line 14percent of the provider fee portion of said supplemental medicaid
Page 45, Line 15payments to initiate the payment to any provider who complies with the established performance measures during the state fiscal year.
Page 45, Line 16(b) The provider fees shall be charged on a nonmedicare-resident
Page 45, Line 17day basis and shall be based upon the aggregate gross or net revenue, as
Page 45, Line 18prescribed by the state department, of all nursing facility providers subject
Page 45, Line 19to the provider fee. The state department may exempt revenue categories
Page 45, Line 20from the gross or net revenue calculation and the collection of the provider fee from nursing facility providers, as authorized by federal law.
Page 45, Line 21(c) (I) In accordance with the redistributive method set forth in 42
Page 45, Line 22CFR 433.68 (e)(1) and (e)(2), the state department shall seek a waiver
Page 45, Line 23from the broad-based provider fees requirement or the uniform provider
Page 46, Line 1fees requirement, or both, to exclude nursing facility providers from the
Page 46, Line 2provider fee. The state department shall exempt the following nursing
Page 46, Line 3facility providers to obtain federal approval and minimize the financial impact on nursing facility providers:
Page 46, Line 4(A) A facility operated as a continuing care retirement community
Page 46, Line 5that provides a continuum of services by one operational entity providing
Page 46, Line 6independent living services, assisted living services, and skilled nursing
Page 46, Line 7care on a single, contiguous campus. Assisted living services include an
Page 46, Line 8assisted living residence as defined in section 25-27-102 or that provides
Page 46, Line 9assisted living services on-site, twenty-four hours per day, seven days per week.
Page 46, Line 10(B) A skilled nursing facility owned and operated by the state;
Page 46, Line 11(C) A nursing facility that is a distinct part of a facility that is licensed as a general acute care hospital; and
Page 46, Line 12(D) A facility that has forty-five or fewer licensed beds.
Page 46, Line 13(II) No later than July 1, 2026, the state department shall
Page 46, Line 14promulgate rules maintaining the exemptions identified in this subsection
Page 46, Line 15(1)(c) in order to minimize the financial impact on nursing facility providers.
Page 46, Line 16(III) This subsection (1)(c) is repealed, effective July 1, 2028.
Page 46, Line 17(d) The state department may lower the amount of the provider fee
Page 46, Line 18charged to certain nursing facility providers to meet the requirements of 42 CFR 433.68 (e) and to obtain federal approval.
Page 46, Line 19(e) The imposition and collection of a provider fee shall be
Page 46, Line 20prohibited without the federal government's approval of a state medicaid
Page 46, Line 21plan amendment authorizing federal financial participation for the
Page 46, Line 22provider fees. The state department may alter the method prescribed in
Page 47, Line 1this section to the extent necessary to meet the federal requirements and to obtain federal approval.
Page 47, Line 2(f) If the provider fee required by this subsection (1) is not
Page 47, Line 3approved by the federal government, notwithstanding any other provision
Page 47, Line 4of this section, the state department shall not implement the assessment or collection of the provider fee from nursing facility providers.
Page 47, Line 5(g) The state department shall establish a schedule to assess and
Page 47, Line 6collect the provider fee on a monthly basis. The state board shall establish
Page 47, Line 7rules so that provider fee payments from a nursing facility provider and
Page 47, Line 8the state department's supplemental medicaid payments to the nursing
Page 47, Line 9facility are due as nearly simultaneously as feasible; except that the state
Page 47, Line 10department's supplemental medicaid payments to the nursing facility shall
Page 47, Line 11be due no more than fifteen days after the provider fee payment is
Page 47, Line 12received from the nursing facility. The state department shall require each
Page 47, Line 13nursing facility provider to report annually its total number of days of care provided to nonmedicare residents.
Page 47, Line 14(h) The state department shall not assess or collect the provider
Page 47, Line 15fee until state medicaid plan amendments adopting the medicaid
Page 47, Line 16reimbursement system for the state's class I nursing facility providers,
Page 47, Line 17pursuant to section 25.5-6-202, including the waiver with respect to the
Page 47, Line 18provider fees pursuant to this section, have been approved by the federal government.
Page 47, Line 19(i) The state board shall promulgate any rules pursuant to the
Page 47, Line 20"State Administrative Procedure Act", article 4 of title 24, C.R.S., necessary for the administration and implementation of this section.
Page 47, Line 21(j) A nursing facility provider shall not include any amount of the
Page 47, Line 22provider fee as a separate line item in its billing statements.
Page 48, Line 1(2) (a.5) Notwithstanding any provision of this subsection
Page 48, Line 2(2) to the contrary, on June 30, 2025, the state treasurer shall
Page 48, Line 3transfer the balance of the fund to the healthcare
Page 48, Line 4affordability and sustainability nursing facility provider fee cash fund created in section 25.5-4-402.4 (5.5).
Page 48, Line 5(3) This section is repealed, effective July 1, 2025.
Page 48, Line 6SECTION 6. In Colorado Revised Statutes, 25.5-6-204, amend (1)(c) as follows:
Page 48, Line 725.5-6-204. Providers - reimbursement - intermediate care
Page 48, Line 8facility for individuals with intellectual disabilities - reimbursement
Page 48, Line 9- maximum allowable - repeal. (1) (c) (I) Beginning in fiscal year
Page 48, Line 102013-14, and for each fiscal year thereafter, the state department is
Page 48, Line 11authorized to charge both privately owned intermediate care facilities for
Page 48, Line 12individuals with intellectual disabilities and state-operated intermediate
Page 48, Line 13care facilities for individuals with intellectual disabilities a service fee for
Page 48, Line 14the purposes of maintaining the quality and continuity of services
Page 48, Line 15provided by intermediate care facilities for individuals with intellectual
Page 48, Line 16disabilities. The service fee charged by the state department pursuant to
Page 48, Line 17this paragraph (c) will be assessed pursuant to rules adopted by the state
Page 48, Line 18board but must not exceed five percent of the total costs incurred by all
Page 48, Line 19intermediate care facilities for the fiscal year in which the service fee is
Page 48, Line 20charged. The state board shall adopt rules consistent with federal law in order to implement the provisions of this paragraph (c).
Page 48, Line 21(II) The moneys collected in each fiscal year pursuant to
Page 48, Line 22subparagraph (I) of this paragraph (c) shall be transmitted by the state
Page 48, Line 23department to the state treasurer, who shall credit the same to
Page 48, Line 24fee fund which fundherebyparagraph (c)
Page 49, Line 1subsection (1)(c) as the "fund". The moneys
Page 49, Line 2subject to annual appropriation by the general assembly to the state
Page 49, Line 3department to be used toward the state match for the federal financial
Page 49, Line 4participation to reimburse intermediate care facilities for individuals with
Page 49, Line 5intellectual disabilities pursuant to this section. Any unexpended and
Page 49, Line 6unencumbered moneys
Page 49, Line 7fiscal year shall remain in the fund and not be credited or transferred to the general fund or any other fund.
Page 49, Line 8(III) (A) Notwithstanding any provision of this subsection
Page 49, Line 9(1)(c) to the contrary, on June 30, 2025, the state treasurer shall
Page 49, Line 10transfer the balance of the service fee fund to the healthcare
Page 49, Line 11affordability and sustainability intermediate care facility fee cash fund created in section 25.5-4-402.4 (5.7).
Page 49, Line 12(B) This subsection (1)(c) is repealed, effective July 1, 2025.
Page 49, Line 13SECTION 7. In Colorado Revised Statutes, 25.5-6-210, amend (4)(b) as follows:
Page 49, Line 1425.5-6-210. Additional supplemental payments - nursing
Page 49, Line 15facilities - funding methodology - reporting requirement - rules -
Page 49, Line 16repeal. (4) (b) For the purposes of federal upper payment limit
Page 49, Line 17calculations, the state department shall pursue federal matching funds for
Page 49, Line 18payments made pursuant to this section but only after securing federal
Page 49, Line 19matching funds for payments outlined in sections 25.5-6-203 (2)
Page 49, Line 20SECTION 8. In Colorado Revised Statutes, 25-3-108, amend (7) as follows:
Page 49, Line 2125-3-108. Receivership. (7) The department of public health and
Page 49, Line 22environment shall grant the receiver a license pursuant to section
Page 50, Line 125-3-102 and shall recommend certification for medicaid participation,
Page 50, Line 2and the department of health care policy and financing and the
Page 50, Line 3Colorado healthcare affordability and sustainability
Page 50, Line 4enterprise shall reimburse the receiver for the long-term health-care
Page 50, Line 5facility's medicaid residents pursuant to section C.R.S.
Page 50, Line 6SECTION 9. In Colorado Revised Statutes, amend 2-3-119 as follows:
Page 50, Line 72-3-119. Audit of healthcare affordability and sustainability
Page 50, Line 8hospital provider fee - cost shift. At the discretion of the legislative
Page 50, Line 9audit committee, the state auditor shall conduct or cause to be conducted
Page 50, Line 10a performance and fiscal audit of the healthcare affordability and
Page 50, Line 11sustainability hospital provider fee established pursuant to section 25.5-4-402.4.
Page 50, Line 12SECTION 10. In Colorado Revised Statutes, 7-121-401, amend (33.5)(b)(V) as follows:
Page 50, Line 137-121-401. General definitions. As used in articles 121 to 137 of this title 7, unless the context otherwise requires:
Page 50, Line 14(33.5) (b) Notwithstanding subsection (33.5)(a) of this section, "residential nonprofit corporation" does not include:
Page 50, Line 15(V) A continuing care retirement community, as described in
Page 50, Line 16section 25.5-6-203, C.R.S.
Page 50, Line 17SECTION 11. In Colorado Revised Statutes, 10-16-1205, amend (5)(a) as follows:
Page 50, Line 1810-16-1205. Health insurance affordability fee - special
Page 50, Line 19assessment on hospitals - allocation of revenues. (5) (a) The special
Page 51, Line 1assessments on hospitals under subsection (1)(a)(II) of this section must
Page 51, Line 2comply with and not violate 42 CFR 433.68. If the federal centers for
Page 51, Line 3medicare and medicaid services in the United States department of health
Page 51, Line 4and human services informs the state that the state will not be in
Page 51, Line 5compliance with 42 CFR 433.68 as a result of the special assessment on
Page 51, Line 6hospitals pursuant to subsection (1)(a)(II) of this section, the enterprise
Page 51, Line 7shall reduce the amount of the special assessment as necessary to avoid
Page 51, Line 8any reduction in the healthcare affordability and sustainability hospital provider fee collected pursuant to section 25.5-4-402.4.
Page 51, Line 9SECTION 12. In Colorado Revised Statutes, 25.5-4-402.8, amend (2)(g)(I) as follows:
Page 51, Line 1025.5-4-402.8. Hospital transparency report and requirements
Page 51, Line 11- definitions. (2) (g) (I) If a hospital does not provide all of the
Page 51, Line 12information required pursuant to subsection (2)(b) of this section, the
Page 51, Line 13state department shall inform the hospital of its noncompliance within
Page 51, Line 14sixty days and identify the information that needs to be provided. If a
Page 51, Line 15hospital does not comply, the state department shall issue a corrective
Page 51, Line 16action plan with a timeline of sixty days required for compliance. If a
Page 51, Line 17hospital continues to not comply, the state department may create a
Page 51, Line 18mandatory pay-for-reporting compliance measure within the hospital
Page 51, Line 19transformation program that is tied to the healthcare affordability and
Page 51, Line 20sustainability hospital provider fee supplemental payment and is based on compliance with subsection (2)(b) of this section.
Page 51, Line 21SECTION 13. In Colorado Revised Statutes, 25.5-5-201, amend (1)(o)(II) and (1)(r)(II) as follows:
Page 51, Line 2225.5-5-201. Optional provisions - optional groups - rules.
Page 51, Line 23(1) (o) (II) Notwithstanding the provisions of subsection (1)(o)(I) of this
Page 52, Line 1section, if the money in the healthcare affordability and sustainability
Page 52, Line 2hospital provider fee cash fund established pursuant to section
Page 52, Line 325.5-4-402.4, together with the corresponding federal matching funds, is
Page 52, Line 4insufficient to fully fund all of the purposes described in section
Page 52, Line 525.5-4-402.4 (5)(b), after receiving recommendations from the Colorado
Page 52, Line 6healthcare affordability and sustainability enterprise established pursuant
Page 52, Line 7to section 25.5-4-402.4 (3), for individuals with disabilities who are
Page 52, Line 8participating in the medicaid buy-in program established in part 14 of
Page 52, Line 9article 6 of this title 25.5, the state board by rule adopted pursuant to the
Page 52, Line 10provisions of section 25.5-4-402.4 (6)(b)(III) may reduce the medical
Page 52, Line 11benefits offered or the percentage of the federal poverty line to below four hundred fifty percent or may eliminate this eligibility group.
Page 52, Line 12(r) (II) Notwithstanding the provisions of subsection (1)(r)(I) of
Page 52, Line 13this section, if the money in the healthcare affordability and sustainability
Page 52, Line 14hospital provider fee cash fund established pursuant to section
Page 52, Line 1525.5-4-402.4, together with the corresponding federal matching funds, is
Page 52, Line 16insufficient to fully fund all of the purposes described in section
Page 52, Line 1725.5-4-402.4 (5)(b), after receiving recommendations from the Colorado
Page 52, Line 18healthcare affordability and sustainability enterprise established pursuant
Page 52, Line 19to section 25.5-4-402.4 (3), for persons eligible for a medicaid buy-in
Page 52, Line 20program established pursuant to section 25.5-5-206, the state board by
Page 52, Line 21rule adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III)
Page 52, Line 22may reduce the medical benefits offered, or the percentage of the federal poverty line, or may eliminate this eligibility group.
Page 52, Line 23SECTION 14. In Colorado Revised Statutes, 25.5-5-204.5, amend (2) as follows:
Page 52, Line 2425.5-5-204.5. Continuous eligibility - children.
Page 53, Line 1(2) Notwithstanding the provisions of subsection (1) of this section, if the
Page 53, Line 2money in the healthcare affordability and sustainability hospital
Page 53, Line 3provider fee cash fund established pursuant to section 25.5-4-402.4,
Page 53, Line 4together with the corresponding federal matching funds, is insufficient to
Page 53, Line 5fully fund all of the purposes described in section 25.5-4-402.4 (5)(b),
Page 53, Line 6after receiving recommendations from the Colorado healthcare
Page 53, Line 7affordability and sustainability enterprise established pursuant to section
Page 53, Line 825.5-4-402.4 (3), the state board by rule adopted pursuant to the
Page 53, Line 9provisions of section 25.5-4-402.4 (6)(b)(III) may eliminate the continuous enrollment requirement pursuant to this section.
Page 53, Line 10SECTION 15. In Colorado Revised Statutes, 25.5-6-1403, amend (5)(b) as follows:
Page 53, Line 1125.5-6-1403. Waivers and amendments. (5) (b) The state
Page 53, Line 12department shall not prepare and submit the amendments to the state
Page 53, Line 13medical assistance plan pursuant to this subsection (5) if there are
Page 53, Line 14insufficient revenues from the healthcare affordability and sustainability
Page 53, Line 15hospital provider fee cash fund, created in section 25.5-4-402.4, for the
Page 53, Line 16administrative expenses associated with preparing and submitting the
Page 53, Line 17state plan amendments. If there are insufficient revenues from the
Page 53, Line 18healthcare affordability and sustainability hospital provider fee cash
Page 53, Line 19fund, the state department may accept and expend gifts, grants, or donations for this purpose.
Page 53, Line 20SECTION 16. In Colorado Revised Statutes, 25.5-8-103, amend (4)(a)(II) and (4)(b)(II) as follows:
Page 53, Line 2125.5-8-103. Definitions - rules. As used in this article 8, unless the context otherwise requires:
Page 53, Line 22(4) "Eligible person" means:
Page 54, Line 1(a) (II) Notwithstanding the provisions of subsection (4)(a)(I) of
Page 54, Line 2this section, if the money in the healthcare affordability and sustainability
Page 54, Line 3hospital provider fee cash fund established pursuant to section
Page 54, Line 425.5-4-402.4 (5), together with the corresponding federal matching funds,
Page 54, Line 5is insufficient to fully fund all of the purposes described in section
Page 54, Line 625.5-4-402.4 (5)(b), after receiving recommendations from the Colorado
Page 54, Line 7healthcare affordability and sustainability enterprise established pursuant
Page 54, Line 8to section 25.5-4-402.4 (3), for persons less than nineteen years of age,
Page 54, Line 9the state board may by rule adopted pursuant to the provisions of section
Page 54, Line 1025.5-4-402.4 (6)(b)(III) reduce the percentage of the federal poverty line
Page 54, Line 11to below two hundred sixty percent, but the percentage shall not be reduced to below two hundred thirteen percent.
Page 54, Line 12(b) (II) Notwithstanding the provisions of subsection (4)(b)(I) of
Page 54, Line 13this section, if the money in the healthcare affordability and sustainability
Page 54, Line 14hospital provider fee cash fund established pursuant to section
Page 54, Line 1525.5-4-402.4 (5), together with the corresponding federal matching funds,
Page 54, Line 16is insufficient to fully fund all of the purposes described in section
Page 54, Line 1725.5-4-402.4 (5)(b), after receiving recommendations from the Colorado
Page 54, Line 18healthcare affordability and sustainability enterprise established pursuant
Page 54, Line 19to section 25.5-4-402.4 (3), for pregnant women, the state board by rule
Page 54, Line 20adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III) may
Page 54, Line 21reduce the percentage of the federal poverty line to below two hundred
Page 54, Line 22sixty percent, but the percentage shall not be reduced to below two hundred thirteen percent.
Page 54, Line 23SECTION 17. Appropriation - adjustments to 2025 long bill.
Page 54, Line 24(1) To implement this act, appropriations made in the annual general
Page 54, Line 25appropriation act for the 2025-26 state fiscal year to the department of
Page 55, Line 1health care policy and financing from the Medicaid nursing facility cash
Page 55, Line 2fund created in section 25.5-6-203 (2)(a), C.R.S., are decreased as follows:
Page 55, Line 3Executive director's office, general administration
Personal services$246,811
Page 55, Line 4Health, life, and dental$30,953
Short-term disability$65
Page 55, Line 5Paid family and medical leave insurance$1,153
Unfunded liability amortization equalization
Page 55, Line 6disbursement payments$15,605
Salary survey$6,899
Page 55, Line 7Step pay$461
PERA direct distribution$5,026
Page 55, Line 8Workers' compensation$788
Operating expenses$13,200
Page 55, Line 9Payment to risk management and property funds$772
Leased space$17,191
Page 55, Line 10Payments to OIT$59,513
CORE operations$123
Page 55, Line 11General professional services and special projects$1,250
Page 55, Line 12Executive director's office, utilization and quality review contracts
Page 55, Line 13Professional services contracts$36,875
Executive director's office, provider audits and services
Page 55, Line 14Professional audit contracts$12,420
Executive director's office, indirect cost recoveries
Page 55, Line 15Indirect cost assessment$12,116
Medical services premiums
Page 56, Line 1Medical and long-term care services for Medicaid
eligible individuals$62,525,000
Page 56, Line 2(2) For the 2025-26 state fiscal year, $62,986,221 is appropriated
Page 56, Line 3to the department of health care policy and financing. This appropriation
Page 56, Line 4is from the healthcare affordability and sustainability nursing facility
Page 56, Line 5provider fee cash fund created in section 25.5-4-402.4 (5.5)(a), C.R.S. To implement this act, the department may use this appropriation as follows:
Page 56, Line 6Executive director's office, general administration
Personal services$246,811
Page 56, Line 7Health, life, and dental$30,953
Short-term disability$65
Page 56, Line 8Paid family and medical leave insurance$1,153
Unfunded liability amortization equalization
Page 56, Line 9disbursement payments$15,605
Salary survey$6,899
Page 56, Line 10Step pay$461
PERA direct distribution$5,026
Page 56, Line 11Workers' compensation$788
Operating expenses$13,200
Page 56, Line 12Payment to risk management and property funds$772
Leased space$17,191
Page 56, Line 13Payments to OIT$59,513
CORE operations$123
Page 56, Line 14General professional services and special projects$1,250
Page 56, Line 15Executive director's office, utilization and quality review
Page 56, Line 16contracts
Professional services contracts$36,875
Page 57, Line 1Executive director's office, provider audits and services
Professional audit contracts$12,420
Page 57, Line 2Executive director's office, indirect cost recoveries
Indirect cost assessment$12,116
Page 57, Line 3Medical services premiums
Medical and long-term care services for Medicaid
Page 57, Line 4eligible individuals$62,525,000
Page 57, Line 5(3) To implement this act, appropriations made in the annual general
Page 57, Line 6appropriation act for the 2025-26 state fiscal year to the department of
Page 57, Line 7health care policy and financing from the service fee fund created in section 25.5-6-204 (1)(c)(II), C.R.S., are decreased as follows:
Page 57, Line 8Executive director's office, general administration
Personal services$36,476
Page 57, Line 9Health, life, and dental$4,955
Short-term disability$15
Page 57, Line 10Paid family and medical leave insurance$169
Unfunded liability amortization equalization
Page 57, Line 11disbursement payments$2,287
Salary survey$1,150
Page 57, Line 12Step pay$67
PERA direct distribution$737
Page 57, Line 13Workers' compensation$116
Operating expenses$1,876
Page 57, Line 14Payment to risk management and property funds$114
Leased space$2,371
Page 57, Line 15Payments to OIT$8,789
CORE operations$18
Page 58, Line 1Executive director's office, indirect cost recoveries
Indirect cost assessment$1,778
Page 58, Line 2Medical services premiums
Medical and long-term care services for Medicaid
Page 58, Line 3eligible individuals$200,460
Page 58, Line 4Transfers to other state department Medicaid-funded programs, human services
Page 58, Line 5Regional centers for people with developmental
disabilities$1,888,903
Page 58, Line 6(4) For the 2025-26 state fiscal year, $2,150,281 is appropriated to the
Page 58, Line 7department of health care policy and financing. This appropriation is from
Page 58, Line 8the healthcare affordability and sustainability intermediate care facility
Page 58, Line 9fee cash fund created in section 25.5-4-402.4 (5.7)(a), C.R.S. To implement this act, the department may use this appropriation as follows:
Page 58, Line 10Executive director's office, general administration
Personal services$36,476
Page 58, Line 11Health, life, and dental$4,955
Short-term disability$15
Page 58, Line 12Paid family and medical leave insurance$169
Unfunded liability amortization equalization
Page 58, Line 13disbursement payments$2,287
Salary survey$1,150
Page 58, Line 14Step pay$67
PERA direct distribution$737
Page 58, Line 15Workers' compensation$116
Page 58, Line 16Operating expenses$1,876
Payment to risk management and property funds$114
Page 59, Line 1Leased space$2,371
Payments to OIT$8,789
Page 59, Line 2CORE operations$18
Executive director's office, indirect cost recoveries
Page 59, Line 3Indirect cost assessment$1,778
Medical services premiums
Page 59, Line 4Medical and long-term care services for Medicaid
eligible individuals$200,460
Page 59, Line 5Transfers to other state department Medicaid-funded programs, human services
Page 59, Line 6Regional centers for people with developmental
disabilities$1,888,903
Page 60, Line 1SECTION 18. Appropriation to the department of health care policy and financing for the fiscal year beginning July 1, 2024. In Session Laws of Colorado 2024, section 2 of chapter 519, (HB 24-1430), amend Part VI (2) and (7)(C)(6), as Part VI (2) and the affected totals are amended by section 1 of SB 25-093, as follows:
Page 60, Line 2Section 2. Appropriation.
Page 60, Line 3Part VI
Page 60, Line 4DEPARTMENT OF HEALTH CARE POLICY AND FINANCING
Page 60, Line 5
Page 60, Line 6(2) MEDICAL SERVICES PREMIUMS
| Agency Name or Title | Item & Subtotal | Total | General Fund | General Fund Exempt | Cash Funds | Reappropriated Funds | Federal Funds |
|---|---|---|---|---|---|---|---|
|
Page 60, Line 7Medical and Long-Term Page 60, Line 8Care Services for Medicaid Page 60, Line 9Eligible Individuals24a |
12,081,998,495 |
2,376,915,878(M) |
1,247,280,333a |
1,399,855,214b |
119,588,730c |
6,938,358,340 |
|
Page 60, Line 10 |
Page 60, Line 11a This amount shall be from the General Fund Exempt Account created in Section 24-77-103.6 (2), C.R.S.
Page 60, Line 12b Of this amount, $1,062,923,207 shall be from the Healthcare Affordability and Sustainability Fee Cash Fund created in Section 25.5-4-402.4 (5)(a), C.R.S., $76,010,738 shall be from
Page 60, Line 13recoveries and recoupments, $58,197,249
Page 61, Line 1funds certified as expenditures incurred by public emergency medical transportation providers, $52,400,466 shall be from the Adult Dental Fund created in Section 25.5-5-207 (4)(a),
Page 61, Line 2C.R.S., $46,929,200 shall be from the Health Care Expansion Fund created in Section 24-22-117 (2)(a)(I), C.R.S., $24,736,077 represents public funds certified as expenditures incurred
Page 61, Line 3by public hospitals and agencies that are eligible for federal financial participation under the Medicaid program, $20,376,822 shall be from the Home- and Community-based Services
Page 61, Line 4Improvement Fund created in Section 25.5-6-1805 (1), C.R.S., $9,781,898 shall be from the Healthcare Affordability and Sustainability nursing facility provider fee
Page 61, Line 5cash fund created in Section 25.5-4-402.4 (5.5)(a), C.R.S., $1,491,000 shall be from the Tobacco Tax Cash Fund created in section 24-22-117 (1)(a), C.R.S., and meets the
Page 61, Line 6requirement to appropriate a portion of the revenues collected from the imposition of additional state cigarette and tobacco taxes to the Old Age Pension program for health related
Page 61, Line 7purposes pursuant to Section 21 of Article X of the State Constitution, $857,151 shall be from the Tobacco Education Programs Fund created in Section 24-22-117 (2)(c)(I), C.R.S.,
Page 61, Line 8$700,000 shall be from an intergovernmental transfer from Denver Health, $550,798 shall be from the Breast and Cervical Cancer Prevention and Treatment Fund created in Section
Page 61, Line 925.5-5-308 (8)(a)(I), C.R.S., $471,682 shall be from the ARPA Home- and Community-Based Services Account created in Section 25.5-4-402.4 (5)(c)(I)(A), C.R.S., and $200,460 shall
Page 61, Line 10be from the Service Fee Fund created in Section 25.5-6-204 (1)(c)(II), C.R.S.
Page 61, Line 11c Of this amount, $107,671,715 shall be transferred from the Department of Higher Education from the Fee-for-service Contracts with State Institutions for Speciality Education
Page 61, Line 12Programs line item, $9,253,841 shall be transferred from the Old Age Pension State Medical Program line item appropriation in the Other Medical Services division of this
Page 61, Line 13department, $1,505,000 shall be from the Department of Early Childhood from the Home Visiting line item, and $1,158,174 shall be transferred from Public School Health Services
Page 61, Line 14line item in the Other Medical Services division of this department.
Page 62, Line 1
Page 62, Line 2(7) TRANSFERS TO OTHER STATE DEPARTMENT MEDICAID-FUNDED PROGRAMS
| Agency Name or Title | Item & Subtotal | Total | General Fund | General Fund Exempt | Cash Funds | Reappropriated Funds | Federal Funds |
|---|---|---|---|---|---|---|---|
Page 62, Line 3(C) Human Services |
Page 62, Line 4(6) Office of Adults, Aging and Disability Services
| Agency Name or Title | Item & Subtotal | Total | General Fund | General Fund Exempt | Cash Funds | Reappropriated Funds | Federal Funds |
|---|---|---|---|---|---|---|---|
Page 62, Line 5Administration |
505,357 |
252,679(M) |
252,678 |
||||
|
Page 62, Line 6Regional Centers for People Page 62, Line 7with Developmental Page 62, Line 8Disabilities |
58,276,921 |
27,249,558(M) |
1,888,903a |
29,138,460 |
|||
|
Page 62, Line 9Community Services for the Page 62, Line 10Elderly |
1,001,800 |
500,900(M) |
500,900 |
||||
Page 62, Line 11 |
59,784,078 |
||||||
Page 62, Line 12 |
Page 62, Line 13aThis
Page 62, Line 14Affordability and Sustainability Intermediate Care Facility Cash Fund created in Section 25.5-4-402.4 (5.7)(a), C.R.S.
Page 62, Line 15
Page 63, Line 1
| Agency Name or Title | Item & Subtotal | Total | General Fund | General Fund Exempt | Cash Funds | Reappropriated Funds | Federal Funds |
|---|---|---|---|---|---|---|---|
Page 63, Line 2TOTALS PART VI |
|||||||
|
Page 63, Line 3(HEALTH CARE Page 63, Line 4POLICY AND Page 63, Line 5FINANCING)30 |
$16,304,072,844 |
$3,819,066,512 |
$1,247,571,367a |
$1,913,251,446b |
$137,592,164 |
$9,186,591,355c |
|
Page 63, Line 6 |
Page 63, Line 7a Of this amount, $1,247,280,333 shall be from the General Fund Exempt Account created in Section 24-77-103.6 (2), C.R.S., and $291,034 shall be General Fund Exempt pursuant
Page 63, Line 8to Section 24-22-117 (1)(c)(I)(B.5), C.R.S. Said $291,034 is not subject to the statutory limitation on General Fund appropriations imposed by Section 24-75-201.1, C.R.S.
Page 63, Line 9b Of this amount, $19,254,185 contains an (I) notation.
Page 63, Line 10c Of this amount, $438,736,989 contains an (I) notation.
Page 63, Line 11SECTION 19. Effective date. This act takes effect May 1, 2025.
Page 64, Line 1SECTION 20. Safety clause. The general assembly finds,
Page 64, Line 2determines, and declares that this act is necessary for the immediate
Page 64, Line 3preservation of the public peace, health, or safety or for appropriations for
Page 64, Line 4the support and maintenance of the departments of the state and state institutions.