House Bill 25-1213 Preamended

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.

• This Unofficial Version Includes Committee

• Amendments Not Yet Adopted on Second Reading

• 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 - definition. (3) (a)  Rules adopted by the state board

• Page 2, Line 5pursuant to subsection (1) of this section must exempt an

• Page 2, Line 6assisted living residence with fewer than nineteen beds from

• Page 2, Line 7complying with the facility guideline institute (FGI) guidelines,

• Page 2, Line 8except in the case of new construction or major renovations. An

• Page 2, Line 9assisted living residence with fewer than nineteen beds must

• Page 2, Line 10still comply with all other fire and local building codes and the standards outlined in this section.

• Page 2, Line 11(b)  For purposes of subsection (3)(a) of this section, "major

• Page 2, Line 12renovations" means additions to a building's structure or

• Page 3, Line 1changes that affect the structural integrity of the building.

• Page 3, Line 2Major renovations do not include changing the functional

• Page 3, Line 3operation of a space if no construction is completed and the

• Page 3, Line 4floor plan of the building remains the same. It also does not

• Page 3, Line 5include adding beds to accommodate more residents or upgrades

• Page 3, Line 6to the heating or cooling systems and electrical systems if those improvements do not require construction.

• Page 3, Line 7SECTION 2.  In Colorado Revised Statutes, add 25.5-1-135 as follows:

• Page 3, Line 825.5-1-135.  Billing manual.Using existing resources

• Page 3, Line 9allocated for billing manual reviews, the state department

• Page 3, Line 10shall establish a process to review and update the general

• Page 3, Line 11billing manual on an annual basis, which must ensure that the

• Page 3, Line 12general billing manual includes all necessary CPT codes, or provides links to the state department's list of CPT codes.

• Page 3, Line 14SECTION 3.  In Colorado Revised Statutes, 25.5-5-402, add(7.3) as follows:

• Page 3, Line 1525.5-5-402.  Statewide managed care system - rules -

• Page 3, Line 16definitions.(7.3) (a)  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 19(b)  The state department shall notify the MCOs of any

• Page 3, Line 20change to the provider rates within sixty days of changing the provider rates.

• Page 3, Line 21SECTION 4.  In Colorado Revised Statutes, add 25.5-5-427 as follows:

• 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 annually publish the following information on its website:

• Page 4, Line 7(a)  The information received pursuant to subsection (1) of this section;

• Page 4, Line 8(b)  Historicalmedicalloss ratio data for each MCE; and

• Page 4, Line 9(c)  Audit findings regarding an MCE's most recently completed medical loss ratio audit.

• Page 4, Line 10(3)  For purposes of subsection (1) of this section, "medical

• Page 4, Line 11loss ratio" means the percentage of premium revenue that the

• Page 4, Line 12MCE spends on health-care services and quality improvement activities.

• Page 4, Line 13SECTION 5.  In Colorado Revised Statutes, add 25.5-6-117 as follows:

• Page 4, Line 1425.5-6-117.  Plan of care - rehabilitation therapy -

• Page 4, Line 15requirements - definition. (1)  As used in the section, unless the

• Page 4, Line 16context otherwise requires, "plan of care" has the same meaning as set forth in section 25.5-6-403.

• Page 4, Line 17(2)  The state department shall not impose signature

• Page 4, Line 18requirements beyond what is required by the federal centers for

• Page 4, Line 19medicare and medicaid services pursuant to 42 CFR 409.43 on a

• Page 5, Line 1physician or practitioner certifying a member's plan of care that

• Page 5, Line 2involves physical therapy, occupational therapy, or speech therapy services.

• Page 5, Line 3SECTION 6.  In Colorado Revised Statutes, add 25.5-6-118 as follows:

• Page 5, Line 425.5-6-118.  Long-term care for members with permanent

• Page 5, Line 5disability. (1)  For a member receiving services through a

• Page 5, Line 6long-term care program pursuant to parts 3 to 10 of this article

• Page 5, Line 76, if a service the member receives is discontinued or is no longer

• Page 5, Line 8a covered service, the state department must confirm the

• Page 5, Line 9timeline for continuity of treatment with the federal centers

• Page 5, Line 10for medicare and medicaid during the transition period of the

• Page 5, Line 11benefit or service being discontinued. Upon confirmation, the

• Page 5, Line 12state department shall communicate the timeline to the member impacted by the benefit or service being discontinued.

• Page 5, Line 13(2)  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 7.  In Colorado Revised Statutes, 25.5-6-2001, amend (2)(a), (2)(c)(II), (2)(c)(III), (3)(a), and(7)(b) as follows:

• Page 5, Line 1625.5-6-2001.  System of care for children and youth - federal

• Page 5, Line 17authorization - leadership and implementation team - report - rules

• Page 5, Line 18- definition. (2) (a)  No later than November 1, 2024, Thestate

• Page 5, Line 19department shall convene a leadership team that is responsible for the

• Page 5, Line 20decision-making and oversight advising and reviewing the

• Page 5, Line 21development and operation of the system of care for children and

• Page 5, Line 22youth who have complex behavioral health needs.

• Page 6, Line 1(c)  The leadership team has the following duties and responsibilities:

• Page 6, Line 2(II)  To oversee and advise review and advise on the strategic direction of the development of the system of care; and

• Page 6, Line 3(III)  To provide fiscal oversight of the state department's

• Page 6, Line 4development and oversight of the system of care review and comment

• Page 6, Line 5on the state department's fiscal development and oversight of the system of care.

• Page 6, Line 6(3) (a)  No later than October 1, 2024, Thestate department shall

• Page 6, Line 7convene an implementation team that shall create a plan utilizing the

• Page 6, Line 8recommendations from the leadership team, as appropriate, to

• Page 6, Line 9implement the system of care for children and youth who have complex behavioral health needs.

• Page 6, Line 10(7) (b)  Beginning January 2025, and each quarter thereafter, the

• Page 6, Line 11state department shall report progress on the development and

• Page 6, Line 12implementation of the system of care developed pursuant to this section

• Page 6, Line 13to the joint budget committee, the implementation team, the

• Page 6, Line 14leadership team, the senate health and human services

• Page 6, Line 15committee, and the house of representatives health and human

• Page 6, Line 16services committee. The report required by this subsection (7)(b)

• Page 6, Line 17must include the rationale for any recommendation from the leadership team that the department elects not to implement.

• Page 6, Line 18SECTION 8.  Act subject to petition - effective date. This act

• Page 6, Line 19takes effect at 12:01 a.m. on the day following the expiration of the

• Page 6, Line 20ninety-day period after final adjournment of the general assembly; except

• Page 6, Line 21that, if a referendum petition is filed pursuant to section 1 (3) of article V

• Page 6, Line 22of the state constitution against this act or an item, section, or part of this

• Page 7, Line 1act within such period, then the act, item, section, or part will not take

• Page 7, Line 2effect unless approved by the people at the general election to be held in

• Page 7, Line 3November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.