A Bill for an Act
Page 1, Line 101Concerning the creation of the provider stabilization fund
Page 1, Line 102to make provider stabilization payments to eligible
Page 1, Line 103safety net providers that serve low-income, uninsured
Page 1, Line 104populations in the state, and, in connection therewith,
Page 1, Line 105maximizing federal funds to stabilize the health-care
Page 1, Line 106safety net and making an appropriation.
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 creates the provider stabilization fund within the Colorado healthcare affordability and sustainability enterprise (enterprise) to distribute provider stabilization payments to safety net providers who provide services to low-income, uninsured individuals on a sliding-fee schedule or at no cost. Provider stabilization payments will be distributed to eligible safety net providers based on the proportion of low-income, uninsured individuals that an individual provider serves in comparison to the total number of low-income, uninsured individuals served by all eligible safety net providers.
The bill directs the state treasurer to credit interest earnings on the principal in the unclaimed property trust fund to the provider stabilization fund as follows:
- $25 million for the 2025-26 state fiscal year;
- $20 million for the 2026-27 state fiscal year; and
- $15 million for the 2027-28 and subsequent state fiscal years.
The provider stabilization fund also consists of any money the general assembly appropriates, transfers, or credits to the fund and any gifts, grants, or donations the enterprise may receive for the fund. The bill directs the enterprise to leverage money in the provider stabilization fund to obtain federal matching money.
The bill establishes a provider stabilization fund enterprise support board to assist the enterprise in implementing and administering the provider stabilization fund. The enterprise's governing board is required to submit an annual report on the provider stabilization fund to specified committees, the governor, and the medical services board in the department of health care policy and financing.
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. Legislative declaration. (1) The general assembly finds and determines that:
Page 2, Line 3(a) Medicaid, the program administered by the department of
Page 2, Line 4health care policy and financing under the name "Health First Colorado",
Page 2, Line 5is an essential public health coverage program that pays for health care for more than 1.2 million Coloradans;
Page 2, Line 6(b) Medicaid is also a critical component of Colorado's broader
Page 2, Line 7health care system, with thousands of health care providers relying on
Page 2, Line 8payments from medicaid to help sustain their businesses as they serve Coloradans;
Page 3, Line 1(c) Medicaid has a positive impact on Colorado's economy, as
Page 3, Line 2evidenced by data from a 2016 report commissioned by the Colorado
Page 3, Line 3Health Foundation showing that, after the medicaid program expansion
Page 3, Line 4made possible by the federal "Patient Protection and Affordable Care
Page 3, Line 5Act" and Senate Bill 13-200, the state's economy experienced an increase
Page 3, Line 6in the state gross domestic product, an increase in jobs, an increase in annual household earnings, and an increase in general fund revenues;
Page 3, Line 7(d) During the public health emergency caused by the COVID-19
Page 3, Line 8pandemic, the federal government allowed all people enrolled in medicaid
Page 3, Line 9as of March 2020 to retain their benefits during the period of the public health emergency, which lasted until May 2023;
Page 3, Line 10(e) Following the public health emergency, the federal
Page 3, Line 11government required the state to conduct eligibility redeterminations for all medicaid enrollees;
Page 3, Line 12(f) Before the eligibility redetermination, 1.8 million Coloradans
Page 3, Line 13were enrolled in the state's medicaid program, and as of May 2024, the state's medicaid enrollment dropped by over 500,000 to 1.27 million;
Page 3, Line 14(g) From spring of 2023 to spring of 2024, Colorado health care
Page 3, Line 15providers experienced significant increases in the demand for care from
Page 3, Line 16uninsured Coloradans, suggesting that many Coloradans who lost medicaid eligibility became uninsured; and
Page 3, Line 17(h) The increased demand for uncompensated care has had
Page 3, Line 18destabilizing financial effects on safety net providers, leading to reduced access to care for many Coloradans.
Page 3, Line 19(2) The general assembly therefore declares that it is:
Page 3, Line 20(a) Enacting the provider stabilization fund as a short-term solution intended to stabilize certain safety net providers; and
Page 4, Line 1(b) Committed to:
Page 4, Line 2(I) Protecting vital primary care safety net infrastructure in the state;
Page 4, Line 3(II) Ensuring Colorado communities can provide access to care for their residents; and
Page 4, Line 4(III) Working toward long-term sustainability for Colorado's health-care safety net.
Page 4, Line 6SECTION 2. In Colorado Revised Statutes, add part 6 to article 3 of title 25.5 as follows:
Page 4, Line 7PART 6
SAFETY NET PROVIDER STABILIZATION
Page 4, Line 825.5-3-601. Legislative declaration. (1) The general assembly finds and declares that:
Page 4, Line 9(a) Safety net providers in the state incur significant
Page 4, Line 10costs by providing services to a large portion of the state's
Page 4, Line 11low-income, uninsured populations and individuals and families enrolled in medicaid or the children's basic health plan; and
Page 4, Line 12(b) This part 6 is enacted to leverage money loaned from
Page 4, Line 13the unclaimed property trust fund to the provider stabilization
Page 4, Line 14fund to obtain federal matching money to make provider
Page 4, Line 15stabilization payments to eligible safety net providers in order to:
Page 4, Line 16(I) Reduce the underpayment to safety net providers
Page 4, Line 17participating in medicaid or the children's basic health plan and
Page 5, Line 1to provide compensation to safety net providers that provide
Page 5, Line 2services to low-income, uninsured individuals on a sliding-fee schedule or for free;
Page 5, Line 3(II) Ensure access to high-quality, affordable health care for low-income and uninsured populations; and
Page 5, Line 4(III) Maintain the quality and continuity of services
Page 5, Line 5delivered by safety net providers to low-income, uninsured
Page 5, Line 6individuals and individuals and families enrolled in medicaid or the children's basic health plan.
Page 5, Line 725.5-3-602. Definitions.As used in this part 6, unless the context otherwise requires:
Page 5, Line 8(1) "Children's basic health plan" has the same meaning as set forth in section 25.5-8-103 (2).
Page 5, Line 9(2) "Eligible safety net provider" means a safety net
Page 5, Line 10provider determined, pursuant to section 25.5-3-604 (2), to be eligible for a provider stabilization payment.
Page 5, Line 11(3) "Low-income, uninsured individual" means an individual:
Page 5, Line 12(a) Receiving services from a safety net provider;
Page 5, Line 13(b) Whose annual household income is at or below two hundred percent of the federal poverty guideline;
Page 5, Line 14(c) Who is not enrolled in medicaid, medicare, or the children's basic health plan; and
Page 5, Line 15(d) For whom a third party is not paying or reimbursing
Page 5, Line 16the safety net provider for all or a portion of the amount charged for the services provided to the individual.
Page 5, Line 17(4) "Medicaid" means a medical assistance program under articles 4 to 6 of this title 25.5.
Page 6, Line 1(5) "Medicare" means the "Health Insurance for the Aged
Page 6, Line 2Act", title XVIII of the federal "Social Security Act", as amended.
Page 6, Line 3(6) "Provider stabilization fund" or "fund" means the provider stabilization fund created in section 25.5-3-603.
Page 6, Line 4(7) "Provider stabilization fund advisory board" or
Page 6, Line 5"advisory board" means the provider stabilization fund advisory board created in section 25.5-3-605.
Page 6, Line 6(8) "Safety net provider" means:
Page 6, Line 7(a) A comprehensive community behavioral health provider, as defined in section 27-50-101 (11);
Page 6, Line 8(b) A rural health clinic, as defined in 42 U.S.C. sec. 1395x (aa)(2);
Page 6, Line 9(c) A federally qualified health center, as defined in 42 U.S.C. sec. 1395x (aa)(4); or
Page 6, Line 10(d) A health-care provider that is delivering primary care
Page 6, Line 11services and at least fifty percent of whose client caseload is
Page 6, Line 12individuals who are enrolled in medicaid, medicare, or the
Page 6, Line 13children's basic health plan or who are low-income, uninsured
Page 6, Line 14individuals, or any combination of such enrollees or low-income, uninsured individuals.
Page 6, Line 15(9) "Unclaimed property trust fund" means the unclaimed property trust fund created in section 38-13-801 (1).
Page 6, Line 1625.5-3-603. Provider stabilization fund - creation - use.
Page 6, Line 17(1) (a) The provider stabilization fund is created in the state
Page 6, Line 18treasury. The provider stabilization fund consists of:
Page 7, Line 1(I) Money credited to the fund as a loan from the unclaimed property trust fund pursuant to section 38-13-801 (6);
Page 7, Line 2(II) Any other money the general assembly may appropriate, transfer, or credit to the fund; and
Page 7, Line 3(III) Any gifts, grants, or donations the state department may receive from public or private sources for the fund.
Page 7, Line 4(b) (I) (A) Money credited to the fund pursuant to section
Page 7, Line 538-13-801 (6) is an interest-free loan from the unclaimed
Page 7, Line 6property trust fund to the fund. The state department may
Page 7, Line 7accept and expend the money so credited and, except as provided
Page 7, Line 8in subsection (1)(b)(I)(B) of this section, shall repay the loan
Page 7, Line 9received pursuant to section 38-13-801 (6) no later than January 1, 2045.
Page 7, Line 10(B) If, in any state fiscal year that begins on or after July
Page 7, Line 111, 2026, state revenues from sources not excluded from state
Page 7, Line 12fiscal year spending, as defined in section 24-77-102 (17), do not
Page 7, Line 13exceed the limit on state fiscal year spending calculated
Page 7, Line 14pursuant to section 24-77-103, the state department shall
Page 7, Line 15present to the joint budget committee a proposal to repay all or
Page 7, Line 16a portion of the loan earlier than the loan repayment deadline specified in subsection (1)(b)(I)(A) of this section.
Page 7, Line 17(II) A loan made from the unclaimed property trust fund to a separate fund associated with a state department:
Page 7, Line 18(A) Is an interfund loan according to governmental
Page 7, Line 19accounting standards board codification 1800.102, meaning that
Page 7, Line 20the loan is not classified as revenue and is booked as an
Page 7, Line 21interfund receivable or payable; and
Page 8, Line 1(B) Is not state fiscal year spending, as defined in section
Page 8, Line 224-77-102 (17), or state revenues, as defined in section 24-77-103.6
Page 8, Line 3(6)(c), and does not count against either the state fiscal year
Page 8, Line 4spending limit imposed by section 20 of article X of the state
Page 8, Line 5constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I)(G).
Page 8, Line 6(2) The state treasurer shall credit all interest and
Page 8, Line 7income derived from the deposit and investment of money in the
Page 8, Line 8provider stabilization fund to the general fund. The state
Page 8, Line 9treasurer shall invest, as provided by law, any money in the
Page 8, Line 10fund not expended for the purposes specified in section 25.5-3-604.
Page 8, Line 11Money in the fund, other than interest, shall not be transferred
Page 8, Line 12to any other fund and shall not be used for any purpose other than the purposes specified in section 25.5-3-604.
Page 8, Line 13(3) Subject to annual appropriation by the general
Page 8, Line 14assembly, the state department shall expend the money in the
Page 8, Line 15fund and any federal matching money, in accordance with
Page 8, Line 16section 25.5-3-604 (1), to distribute provider stabilization
Page 8, Line 17payments to safety net providers determined eligible for payments in accordance with section 25.5-3-604 (2).
Page 8, Line 18(4) The state department, in collaboration with the
Page 8, Line 19provider stabilization fund advisory board, may seek, accept,
Page 8, Line 20and expend gifts, grants, or donations from private or public
Page 8, Line 21sources for the purposes of section 25.5-3-604. The state
Page 8, Line 22department shall transmit all money received through gifts,
Page 8, Line 23grants, or donations to the state treasurer, who shall credit
Page 8, Line 24the money to the provider stabilization fund.
Page 9, Line 1(5) The state department, in consultation with the
Page 9, Line 2provider stabilization fund advisory board, shall leverage
Page 9, Line 3money in the fund to obtain federal matching money, working
Page 9, Line 4with or through the state board to the extent required by federal law or otherwise necessary.
Page 9, Line 525.5-3-604. Provider stabilization payments - eligibility.
Page 9, Line 6(1) (a) The state department, in collaboration with the provider
Page 9, Line 7stabilization fund advisory board, shall annually allocate
Page 9, Line 8money appropriated by the general assembly from the provider
Page 9, Line 9stabilization fund as provider stabilization payments to safety
Page 9, Line 10net providers in the state that comply with the requirements of
Page 9, Line 11subsection (2) of this section and are determined to be eligible
Page 9, Line 12for a provider stabilization payment. The state department
Page 9, Line 13shall allocate the provider stabilization payments in amounts
Page 9, Line 14proportionate to the number of low-income, uninsured
Page 9, Line 15individuals served by an eligible safety net provider relative to
Page 9, Line 16the total number of low-income, uninsured individuals served by all eligible safety net providers.
Page 9, Line 17(b) The state department, in consultation with the
Page 9, Line 18advisory board, shall establish a schedule for allocating the
Page 9, Line 19money appropriated from the provider stabilization fund for
Page 9, Line 20eligible safety net providers. The disbursement of money in the
Page 9, Line 21provider stabilization fund to eligible safety net providers
Page 9, Line 22pursuant to this section is exempt from the provisions of the "Procurement Code", articles 101 to 112 of title 24.
Page 9, Line 23(c) Provider stabilization payments from the provider
Page 9, Line 24stabilization fund pursuant to this subsection (1) are made to
Page 10, Line 1supplement, not supplant, general fund appropriations to support safety net provider reimbursements.
Page 10, Line 2(2) (a) For a safety net provider to be eligible for a
Page 10, Line 3provider stabilization payment pursuant to subsection (1)(a) of
Page 10, Line 4this section, the safety net provider shall provide sufficient
Page 10, Line 5information to the state department, as specified in subsection
Page 10, Line 6(2)(b) of this section, to establish that the provider provides services to low-income, uninsured individuals:
Page 10, Line 7(I) At no cost; or
(II) On a sliding-fee schedule.
Page 10, Line 8(b) A safety net provider applying for a provider
Page 10, Line 9stabilization payment shall annually submit to the state
Page 10, Line 10department information that the state department, in
Page 10, Line 11consultation with the advisory board, determines necessary to
Page 10, Line 12establish the provider's eligibility for a provider stabilization
Page 10, Line 13payment pursuant to subsection (1)(a) of this section. The safety net provider shall provide the following:
Page 10, Line 14(I) Information demonstrating that the provider is a
Page 10, Line 15safety net provider as described in section 25.5-3-602 (8)(a), (8)(b),
Page 10, Line 16or (8)(c) or has a client caseload that satisfies the requirements of section 25.5-3-602 (8)(d);
Page 10, Line 17(II) For a safety net provider described in section
Page 10, Line 1825.5-3-602 (8)(d), the total number of patients served, the number
Page 10, Line 19of low-income, uninsured individuals that the provider served,
Page 10, Line 20and the number of enrollees in medicaid, medicare, or the children's basic health plan that the provider served; and
Page 10, Line 21(III) Information to demonstrate that the provider
Page 11, Line 1provides services in compliance with subsection (2)(a)(I) or (2)(a)(II) of this section, as applicable.
Page 11, Line 2(c) For purposes of this subsection (2), the number of
Page 11, Line 3patients served is the number of unduplicated users of
Page 11, Line 4health-care services and is not the number of visits by a patient.
Page 11, Line 525.5-3-605. Provider stabilization fund advisory board -
Page 11, Line 6creation - membership - duties - repeal. (1) (a) The provider
Page 11, Line 7stabilization fund advisory board is created to support the
Page 11, Line 8state department with the implementation of this part 6. The
Page 11, Line 9advisory board consists of nine members appointed by the governor as follows:
Page 11, Line 10(I) Five members who are eligible safety net providers or who represent associations of eligible safety net providers;
Page 11, Line 11(II) Three members who are low-income, uninsured
Page 11, Line 12individuals who rely on safety net providers for health care or
Page 11, Line 13who are representatives from Colorado-based consumer
Page 11, Line 14advocacy organizations that work on safety net health-care matters; and
Page 11, Line 15(III) One member who is an employee of the state department.
Page 11, Line 16(b) (I) The governor shall make the initial appointments to
Page 11, Line 17the advisory board as soon as possible after the effective date of this part 6, but no later than August 1, 2025.
Page 11, Line 18(II) Members of the advisory board serve at the pleasure of the governor. The term of appointment is three years.
Page 11, Line 19(c) Members of the advisory board serve without
Page 11, Line 20compensation and without reimbursement for expenses.
Page 12, Line 1(d) The advisory board shall elect a chair and vice-chair
Page 12, Line 2from among its provider and consumer members and shall meet
Page 12, Line 3as necessary at the call of the chair to perform its functions as specified in this part 6.
Page 12, Line 4(2) The advisory board shall consult with the state
Page 12, Line 5department, as well as the state board as necessary, in
Page 12, Line 6implementing this part 6, including assisting the state
Page 12, Line 7department in administering and providing oversight of the
Page 12, Line 8provider stabilization fund and in leveraging the fund to obtain federal matching money.
Page 12, Line 9(3) This section is repealed, effective September 1, 2031.
Page 12, Line 10Before the repeal, the committee is scheduled for review in accordance with section 2-3-1203.
Page 12, Line 1125.5-3-606. Provider stabilization fund report (1) Beginning
Page 12, Line 12September 1, 2026, and by each September 1 thereafter, the state
Page 12, Line 13department, with assistance from the advisory board, shall
Page 12, Line 14prepare and submit an annual report concerning the provider stabilization fund to:
Page 12, Line 15(a) The health and human services committee of the house
Page 12, Line 16of representatives and the health and human services committee of the senate, or their successor committees;
Page 12, Line 17(b) The joint budget committee;
(c) The governor; and
Page 12, Line 18(d) The state board.
(2) At a minimum, the report must include:
Page 12, Line 19(a) The number of low-income, uninsured individuals and
Page 12, Line 20the number of medicaid, medicare, and children's basic health
Page 13, Line 1plan enrollees served by eligible safety net providers that
Page 13, Line 2received provider stabilization payments in the immediately preceding fiscal year;
Page 13, Line 3(b) The allocation of money to eligible safety net
Page 13, Line 4providers, including an itemization of the total amount of
Page 13, Line 5provider stabilization payments allocated to each eligible safety net provider; and
Page 13, Line 6(c) Any other information that the state department, in
Page 13, Line 7consultation with the advisory board, deems necessary or appropriate.
Page 13, Line 8(3) Notwithstanding the requirement in section 24-1-136
Page 13, Line 9(11)(a)(I), the requirement to submit the report required in this section continues indefinitely.
Page 13, Line 10SECTION 3. In Colorado Revised Statutes, 2-3-1203, add (22)(a)(VII) as follows:
Page 13, Line 112-3-1203. Sunset review of advisory committees - legislative
Page 13, Line 12declaration - definition - repeal. (22) (a) The following statutory
Page 13, Line 13authorizations for the designated advisory committees will repeal on September 1, 2031:
Page 13, Line 14(VII) The provider stabilization fund advisory board created in section 25.5-3-605.
Page 13, Line 15SECTION 4. In Colorado Revised Statutes, 38-13-801, amend (1)(c); and add(2)(d), (2)(e), and (6) as follows:
Page 13, Line 1638-13-801. Unclaimed property trust fund - creation -
Page 13, Line 17payments - interest - appropriations - records - rules. (1) (c) Except
Page 13, Line 18as provided in subsection (6) of this section, all interest derived from
Page 13, Line 19the deposit and investment of money in the trust fund shall be credited to
Page 14, Line 1the trust fund. Such interest is not fiscal year spending of the
Page 14, Line 2state for purposes of section 20 of article X of the state constitution.
Page 14, Line 3(2) (d) If claims made pursuant to this article 13 exceed
Page 14, Line 4the balance in the unclaimed property trust fund, the state
Page 14, Line 5treasurer shall transfer from the general fund to the
Page 14, Line 6unclaimed property trust fund an amount needed to pay the
Page 14, Line 7claims and shall notify the joint budget committee of the
Page 14, Line 8general assembly of the transfer and the amount of the transfer from the general fund.
Page 14, Line 9 (e) Interest and, if necessary, principal credited, as
Page 14, Line 10required by subsection (6) of this section, as a loan to the
Page 14, Line 11provider stabilization fund created in section 25.5-3-603 (1)does
Page 14, Line 12not constitute fiscal year spending of the state for purposes of section 20 of article X of the state constitution.
Page 14, Line 13(6) (a) Except as provided in subsection (6)(b) of this
Page 14, Line 14section, the state treasurer shall make an interest-free loan of
Page 14, Line 15interest derived from the deposit and investment of money in the
Page 14, Line 16unclaimed property trust fund to the provider stabilization fund created in section 25.5-3-603 (1)as follows:
Page 14, Line 17(I) On August 1, 2025, twenty-five million dollars;
(II) On August 1, 2026, twenty million dollars; and
Page 14, Line 18(III) On August 1, 2027, August 1, 2028, and August 1, 2029, fifteen million dollars.
Page 14, Line 19(b) If there is an insufficient amount of interest in the
Page 14, Line 20unclaimed property trust fund to enable the state treasurer to
Page 14, Line 21credit the full amount required for a particular state fiscal
Page 15, Line 1year from interest alone, the state treasurer shall credit an
Page 15, Line 2amount of principal in the trust fund that is sufficient to enable
Page 15, Line 3the state treasurer to credit to the provider stabilization fund the full amount required for that state fiscal year.
Page 15, Line 4SECTION 5. Appropriation. (1) For the 2025-26 state fiscal
Page 15, Line 5year, $25,000,000 is appropriated to the department of health care policy
Page 15, Line 6and financing. This appropriation is from the provider stabilization fund
Page 15, Line 7created in section 25.5-3-603 (1)(a), C.R.S. To implement this act, the department may use this appropriation as follows:
Page 15, Line 8(a) $138,505 for personal services related to general
Page 15, Line 9administration, which amount is based on an assumption that the department will require an additional 2.0 FTE;
Page 15, Line 10(b) $15,900 for operating expenses related to general administration; and
Page 15, Line 11(c) $24,845,595 for provider stabilization payments related to other medical services.
Page 15, Line 12SECTION 6. Safety clause. The general assembly finds,
Page 15, Line 13determines, and declares that this act is necessary for the immediate
Page 15, Line 14preservation of the public peace, health, or safety or for appropriations for
Page 15, Line 15the support and maintenance of the departments of the state and state institutions.