A Bill for an Act
Page 1, Line 101Concerning changes to the medical assistance program.
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 exempts an assisted living residence with fewer than 19 beds that has not undergone new construction or renovations and that complies with the standards for assisted living residences from complying with facility guidelines adopted by the state board of health.
The bill requires the department of health care policy and financing (state department) to follow the standards set by the federal centers for medicare and medicaid when updating rules.
The state department must establish a process for reviewing and updating the general billing manual on an annual basis and ensure that the general billing manual includes all necessary CPT codes.
Beginning January 1, 2026, for claims that must be reprocessed as a result of updating the provider rates, the bill requires a managed care organization to issue payment to a contracted provider within one year after the provider rate is updated.
The bill requires the state department to include in each new contract with, or renewal of a contract with, a managed care entity (MCE) a provision requiring the MCE to submit to the state department, on an annual basis, the amount the MCE is paid and the MCE's medical loss ratio. The state department is required to publish this information on the state department's website on an annual basis.
The bill prohibits the state department from imposing signature requirements on a physician or practitioner certifying a medicaid member's (member) plan of care that involves physical therapy or occupational therapy.
The bill prevents a member receiving home- and community-based services from losing the services the member currently receives if the member's disability and need for services have not changed in the preceding 3 years.
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. In Colorado Revised Statutes, 25-27-104, add (3) as follows:
Page 2, Line 325-27-104. Minimum standards for assisted living residences
Page 2, Line 4- rules. (3) Rules adopted by the state board pursuant to
Page 2, Line 5subsection (1) of this section must exempt an assisted living
Page 2, Line 6residence with fewer than nineteen beds that has not undergone
Page 2, Line 7new construction or renovations and that complies with the
Page 2, Line 8standards for assisted living residences outlined in section
Page 2, Line 925-27-104 from complying with facility guidelines adopted by the state board.
Page 2, Line 10SECTION 2. In Colorado Revised Statutes, 25.5-1-108, add (1.5) as follows:
Page 2, Line 1125.5-1-108. Executive director - rules. (1.5) The executive
Page 3, Line 1director shall adopt the standards set by the federal centers
Page 3, Line 2for medicare and medicaid services when updating existing rules
Page 3, Line 3and ensure updates and changes to the rules are easily identifiable.
Page 3, Line 4SECTION 3. In Colorado Revised Statutes, add 25.5-1-135 as follows:
Page 3, Line 525.5-1-135. Billing manual.Using existing resources
Page 3, Line 6allocated for billing manual reviews, the state department
Page 3, Line 7shall establish a process to review and update the general
Page 3, Line 8billing manual on an annual basis, which must ensure that the general billing manual includes all necessary CPT codes.
Page 3, Line 9SECTION 4. In Colorado Revised Statutes, 25.5-1-303, add (10) as follows:
Page 3, Line 1025.5-1-303. Powers and duties of the board - scope of authority
Page 3, Line 11- rules - repeal. (10) The board shall adopt the standards set by
Page 3, Line 12the federal centers for medicare and medicaid services when
Page 3, Line 13updating existing rules and ensure updates and changes to the rules are easily identifiable.
Page 3, Line 14SECTION 5. In Colorado Revised Statutes, 25.5-5-402, add (7.5)(c) as follows:
Page 3, Line 1525.5-5-402. Statewide managed care system - rules -
Page 3, Line 16definitions. (7.5) (c) Beginning January 1, 2026, for a claim that
Page 3, Line 17must be reprocessed as a result of updating the provider rates,
Page 3, Line 18an MCO shall issue payment to the contracted provider within one year after the provider rate is updated.
Page 3, Line 19SECTION 6. In Colorado Revised Statutes, add 25.5-5-427 as
Page 3, Line 20follows:
Page 4, Line 125.5-5-427. Managed care entities - disclosure of payment and
Page 4, Line 2medical loss ratio - definition. (1) The state department shall
Page 4, Line 3include in each new contract with, or renewal of a contract
Page 4, Line 4with, an MCE a provision requiring the MCE to submit to the
Page 4, Line 5state department, on an annual basis, the amount the MCE is paid for delivering services and the MCE's medical loss ratio.
Page 4, Line 6(2) The state department shall publish the information
Page 4, Line 7received pursuant to subsection (1) of this section on its website on an annual basis.
Page 4, Line 8(3) For purposes of subsection (1) of this section, "medical
Page 4, Line 9loss ratio" means the percentage of premium revenue that the
Page 4, Line 10MCE spends on health-care services and quality improvement activities.
Page 4, Line 11SECTION 7. In Colorado Revised Statutes, add 25.5-6-117 as follows:
Page 4, Line 1225.5-6-117. Plan of care - physical therapy and occupational
Page 4, Line 13therapy - requirements - definition. (1) As used in the section,
Page 4, Line 14unless the context otherwise requires, "plan of care" has the same meaning as set forth in section 25.5-6-403.
Page 4, Line 15(2) The state department shall not impose signature
Page 4, Line 16requirements beyond what is required by the federal centers for
Page 4, Line 17medicare and medicaid services pursuant to 42 CFR 409.43 on a
Page 4, Line 18physician or practitioner certifying a member's plan of care that involves physical therapy or occupational therapy services.
Page 4, Line 19SECTION 8. In Colorado Revised Statutes, add 25.5-6-118 as follows:
Page 4, Line 2025.5-6-118. Long-term care for members with permanent
Page 5, Line 1disability. (1) If a member receives services through a long-term
Page 5, Line 2care program pursuant to parts 3 to 10 of this article 6 and the
Page 5, Line 3member's disability or need for services has not changed in the
Page 5, Line 4preceding three years, the state department must continue to
Page 5, Line 5provide the services the member currently receives and is
Page 5, Line 6eligible for to the member unless there is a change in the
Page 5, Line 7member's disability or the services the member currently
Page 5, Line 8receives are no longer needed. This subsection (1) applies even if
Page 5, Line 9the state department discontinues those services for a newly eligible member.
Page 5, Line 10(2) This section does not limit the state department's
Page 5, Line 11ability to increase or decrease the services the member may
Page 5, Line 12receive if a member's disability warrants an increase or decrease in services to adequately meet the member's needs.
Page 5, Line 13(3) This section applies to members who are functionally
Page 5, Line 14and financially eligible to receive long-term care services pursuant to parts 3 to 10 of this article 6.
Page 5, Line 15SECTION 9. Act subject to petition - effective date. This act
Page 5, Line 16takes effect at 12:01 a.m. on the day following the expiration of the
Page 5, Line 17ninety-day period after final adjournment of the general assembly; except
Page 5, Line 18that, if a referendum petition is filed pursuant to section 1 (3) of article V
Page 5, Line 19of the state constitution against this act or an item, section, or part of this
Page 5, Line 20act within such period, then the act, item, section, or part will not take
Page 5, Line 21effect unless approved by the people at the general election to be held in
Page 5, Line 22November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.