Senate Committee of Reference Report

Committee on Finance

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April 22, 2025

After consideration on the merits, the Committee recommends the following:

SB25-290     be amended as follows, and as so amended, be referred to the Committee on Appropriations with favorable recommendation:

Page 1, Line 1Amend printed bill, page 4, strike lines 10 through 27.

Page 1, Line 2Strike pages 5 through 14.

Page 1, Line 3Page 15, strike lines 1 through 16 and substitute:

Page 1, Line 4"SECTION 2.  In Colorado Revised Statutes, add part 6 to article

Page 1, Line 53 of title 25.5 as follows:

Page 1, Line 6PART 6

Page 1, Line 7SAFETY NET PROVIDER STABILIZATION

Page 1, Line 825.5-3-601.  Legislative declaration. (1)  The general

Page 1, Line 9assembly finds and declares that:

Page 1, Line 10(a)  Safety net providers in the state incur significant

Page 1, Line 11costs by providing services to a large portion of the state's

Page 1, Line 12low-income, uninsured populations and individuals and families

Page 1, Line 13enrolled in medicaid or the children's basic health plan; and

Page 1, Line 14(b)  This part 6 is enacted to leverage money loaned from

Page 1, Line 15the unclaimed property trust fund to the provider stabilization

Page 1, Line 16fund to obtain federal matching money to make provider

Page 1, Line 17stabilization payments to eligible safety net providers in order

Page 1, Line 18to:

Page 1, Line 19(I)  Reduce the underpayment to safety net providers

Page 1, Line 20participating in medicaid or the children's basic health plan and

Page 1, Line 21to provide compensation to safety net providers that provide

Page 1, Line 22services to low-income, uninsured individuals on a sliding-fee

Page 1, Line 23schedule or for free;

Page 1, Line 24(II)  Ensure access to high-quality, affordable health care

Page 1, Line 25for low-income and uninsured populations; and

Page 2, Line 1(III)  Maintain the quality and continuity of services

Page 2, Line 2delivered by safety net providers to low-income, uninsured

Page 2, Line 3individuals and individuals and families enrolled in medicaid or

Page 2, Line 4the children's basic health plan.

Page 2, Line 525.5-3-602.  Definitions. As used in this part 6, unless the

Page 2, Line 6context otherwise requires:

Page 2, Line 7(1)  "Children's basic health plan" has the same meaning as

Page 2, Line 8set forth in section 25.5-8-103 (2).

Page 2, Line 9(2)  "Eligible safety net provider" means a safety net

Page 2, Line 10provider determined, pursuant to section 25.5-3-604 (2), to be

Page 2, Line 11eligible for a provider stabilization payment.

Page 2, Line 12(3)  "Low-income, uninsured individual" means an

Page 2, Line 13individual:

Page 2, Line 14(a)  Receiving services from a safety net provider;

Page 2, Line 15(b)  Whose annual household income is at or below two

Page 2, Line 16hundred percent of the federal poverty guideline;

Page 2, Line 17(c)  Who is not enrolled in medicaid, medicare, or the

Page 2, Line 18children's basic health plan; and

Page 2, Line 19(d)  For whom a third party is not paying or reimbursing

Page 2, Line 20the safety net provider for all or a portion of the amount

Page 2, Line 21charged for the services provided to the individual.

Page 2, Line 22(4)  "Medicaid" means a medical assistance program under

Page 2, Line 23articles 4 to 6 of this title 25.5.

Page 2, Line 24(5)  "Medicare" means the "Health Insurance for the Aged

Page 2, Line 25Act", title XVIII of the federal "Social Security Act", as

Page 2, Line 26amended.

Page 2, Line 27(6)  "Provider stabilization fund" or "fund" means the

Page 2, Line 28provider stabilization fund created in section 25.5-3-603.

Page 2, Line 29(7)  "Provider stabilization fund advisory board" or

Page 2, Line 30"advisory board" means the provider stabilization fund advisory

Page 2, Line 31board created in section 25.5-3-605.

Page 2, Line 32(8)  "Safety net provider" means:

Page 2, Line 33(a)  A comprehensive community behavioral health

Page 2, Line 34provider, as defined in section 27-50-101 (11);

Page 2, Line 35(b)  A rural health clinic, as defined in 42 U.S.C. sec. 1395x

Page 2, Line 36(aa)(2);

Page 2, Line 37(c)  A federally qualified health center, as defined in 42

Page 2, Line 38U.S.C. sec. 1395x (aa)(4); or

Page 2, Line 39(d)  A health-care provider that is delivering primary care

Page 2, Line 40services and at least fifty percent of whose client caseload is

Page 2, Line 41individuals who are enrolled in medicaid, medicare, or the

Page 2, Line 42children's basic health plan or who are low-income, uninsured

Page 2, Line 43individuals, or any combination of such enrollees or

Page 3, Line 1low-income, uninsured individuals.

Page 3, Line 2(9)  "Unclaimed property trust fund" means the unclaimed

Page 3, Line 3property trust fund created in section 38-13-801 (1).

Page 3, Line 425.5-3-603.  Provider stabilization fund - creation - use.

Page 3, Line 5(1) (a)  The provider stabilization fund is created in the state

Page 3, Line 6treasury. The provider stabilization fund consists of:

Page 3, Line 7(I)  Money credited to the fund as a loan from the

Page 3, Line 8unclaimed property trust fund pursuant to section 38-13-801 (6);

Page 3, Line 9(II)  Any other money the general assembly may

Page 3, Line 10appropriate, transfer, or credit to the fund; and

Page 3, Line 11(III)  Any gifts, grants, or donations the state department

Page 3, Line 12may receive from public or private sources for the fund.

Page 3, Line 13(b) (I) (A)  Money credited to the fund pursuant to section

Page 3, Line 1438-13-801 (6) is an interest-free loan from the unclaimed

Page 3, Line 15property trust fund to the fund. The state department may

Page 3, Line 16accept and expend the money so credited and, except as provided

Page 3, Line 17in subsection (1)(b)(I)(B) of this section, shall repay the loan

Page 3, Line 18received pursuant to section 38-13-801 (6) no later than January

Page 3, Line 191, 2045.

Page 3, Line 20(B)  If, in any state fiscal year that begins on or after July

Page 3, Line 211, 2026, state revenues from sources not excluded from state

Page 3, Line 22fiscal year spending, as defined in section 24-77-102 (17), do not

Page 3, Line 23exceed the limit on state fiscal year spending calculated

Page 3, Line 24pursuant to section 24-77-103, the state department shall

Page 3, Line 25present to the joint budget committee a proposal to repay all or

Page 3, Line 26a portion of the loan earlier than the loan repayment deadline

Page 3, Line 27specified in subsection (1)(b)(I)(A) of this section.

Page 3, Line 28(II)  A loan made from the unclaimed property trust fund

Page 3, Line 29to a separate fund associated with a state department:

Page 3, Line 30(A)  Is an interfund loan according to governmental

Page 3, Line 31accounting standards board codification 1800.102, meaning that

Page 3, Line 32the loan is not classified as revenue and is booked as an

Page 3, Line 33interfund receivable or payable; and

Page 3, Line 34(B)  Is not state fiscal year spending, as defined in section

Page 3, Line 3524-77-102 (17), or state revenues, as defined in section 24-77-103.6

Page 3, Line 36(6)(c), and does not count against either the state fiscal year

Page 3, Line 37spending limit imposed by section 20 of article X of the state

Page 3, Line 38constitution or the excess state revenues cap, as defined in

Page 3, Line 39section 24-77-103.6 (6)(b)(I)(G).

Page 3, Line 40(2)  The state treasurer shall credit all interest and

Page 3, Line 41income derived from the deposit and investment of money in the

Page 3, Line 42provider stabilization fund to the fund. The state treasurer

Page 3, Line 43shall invest, as provided by law, any money in the fund not

Page 4, Line 1expended for the purposes specified in section 25.5-3-604. Money

Page 4, Line 2in the fund shall not be transferred to any other fund and shall

Page 4, Line 3not be used for any purpose other than the purposes specified in

Page 4, Line 4section 25.5-3-604.

Page 4, Line 5(3)  All money in the fund is subject to federal matching as

Page 4, Line 6authorized under federal law and, subject to annual

Page 4, Line 7appropriation by the general assembly, the state department

Page 4, Line 8shall expend the money in the fund and federal matching money,

Page 4, Line 9in accordance with section 25.5-3-604 (1), to distribute provider

Page 4, Line 10stabilization payments to safety net providers determined

Page 4, Line 11eligible for payments in accordance with section 25.5-3-604 (2).

Page 4, Line 12(4)  The state department, in collaboration with the

Page 4, Line 13provider stabilization fund advisory board, may seek, accept,

Page 4, Line 14and expend gifts, grants, or donations from private or public

Page 4, Line 15sources for the purposes of section 25.5-3-604. The state

Page 4, Line 16department shall transmit all money received through gifts,

Page 4, Line 17grants, or donations to the state treasurer, who shall credit

Page 4, Line 18the money to the provider stabilization fund.

Page 4, Line 19(5)  The state department, in consultation with the

Page 4, Line 20provider stabilization fund advisory board, shall leverage

Page 4, Line 21money in the fund to obtain federal matching money, working

Page 4, Line 22with or through the state board to the extent required by

Page 4, Line 23federal law or otherwise necessary.

Page 4, Line 2425.5-3-604.  Provider stabilization payments - eligibility.

Page 4, Line 25(1) (a)  The state department, in collaboration with the provider

Page 4, Line 26stabilization fund advisory board, shall annually allocate

Page 4, Line 27money appropriated by the general assembly from the provider

Page 4, Line 28stabilization fund as provider stabilization payments to safety

Page 4, Line 29net providers in the state that comply with the requirements of

Page 4, Line 30subsection (2) of this section and are determined to be eligible

Page 4, Line 31for a provider stabilization payment. The state department

Page 4, Line 32shall allocate the provider stabilization payments in amounts

Page 4, Line 33proportionate to the number of low-income, uninsured

Page 4, Line 34individuals served by an eligible safety net provider relative to

Page 4, Line 35the total number of low-income, uninsured individuals served by

Page 4, Line 36all eligible safety net providers.

Page 4, Line 37(b)  The state department, in consultation with the

Page 4, Line 38advisory board, shall establish a schedule for allocating the

Page 4, Line 39money appropriated from the provider stabilization fund for

Page 4, Line 40eligible safety net providers. The disbursement of money in the

Page 4, Line 41provider stabilization fund to eligible safety net providers

Page 4, Line 42pursuant to this section is exempt from the provisions of the

Page 4, Line 43"Procurement Code", articles 101 to 112 of title 24.

Page 5, Line 1(c)  Provider stabilization payments from the provider

Page 5, Line 2stabilization fund pursuant to this subsection (1) are made to

Page 5, Line 3supplement, not supplant, general fund appropriations to

Page 5, Line 4support safety net provider reimbursements.

Page 5, Line 5(2) (a)  For a safety net provider to be eligible for a

Page 5, Line 6provider stabilization payment pursuant to subsection (1)(a) of

Page 5, Line 7this section, the safety net provider shall provide sufficient

Page 5, Line 8information to the state department, as specified in subsection

Page 5, Line 9(2)(b) of this section, to establish that the provider provides

Page 5, Line 10services to low-income, uninsured individuals:

Page 5, Line 11(I)  At no cost; or

Page 5, Line 12(II)  On a sliding-fee schedule.

Page 5, Line 13(b)  A safety net provider applying for a provider

Page 5, Line 14stabilization payment shall annually submit to the state

Page 5, Line 15department information that the state department, in

Page 5, Line 16consultation with the advisory board, determines necessary to

Page 5, Line 17establish the provider's eligibility for a provider stabilization

Page 5, Line 18payment pursuant to subsection (1)(a) of this section. The safety

Page 5, Line 19net provider shall provide the following:

Page 5, Line 20(I)  Information demonstrating that the provider is a

Page 5, Line 21safety net provider as described in section 25.5-3-602 (8)(a), (8)(b),

Page 5, Line 22or (8)(c) or has a client caseload that satisfies the requirements

Page 5, Line 23of section 25.5-3-602 (8)(d);

Page 5, Line 24(II)  For a safety net provider described in section

Page 5, Line 2525.5-3-602 (8)(d), the total number of patients served, the number

Page 5, Line 26of low-income, uninsured individuals that the provider served,

Page 5, Line 27and the number of enrollees in medicaid, medicare, or the

Page 5, Line 28children's basic health plan that the provider served; and

Page 5, Line 29(III)  Information to demonstrate that the provider

Page 5, Line 30provides services in compliance with subsection (2)(a)(I) or

Page 5, Line 31(2)(a)(II) of this section, as applicable.

Page 5, Line 32(c)  For purposes of this subsection (2), the number of

Page 5, Line 33patients served is the number of unduplicated users of

Page 5, Line 34health-care services and is not the number of visits by a patient.

Page 5, Line 3525.5-3-605.  Provider stabilization fund advisory board -

Page 5, Line 36creation - membership - duties - repeal. (1) (a)  The provider

Page 5, Line 37stabilization fund advisory board is created to support the

Page 5, Line 38state department with the implementation of this part 6. The

Page 5, Line 39advisory board consists of nine members appointed by the

Page 5, Line 40governor as follows:

Page 5, Line 41(I)  Five members who are eligible safety net providers or

Page 5, Line 42who represent associations of eligible safety net providers;

Page 5, Line 43(II)  Three members who are low-income, uninsured

Page 6, Line 1individuals who rely on safety net providers for health care or

Page 6, Line 2who are representatives from Colorado-based consumer

Page 6, Line 3advocacy organizations that work on safety net health-care

Page 6, Line 4matters; and

Page 6, Line 5(III)  One member who is an employee of the state

Page 6, Line 6department.

Page 6, Line 7(b) (I)  The governor shall make the initial appointments to

Page 6, Line 8the advisory board as soon as possible after the effective date

Page 6, Line 9of this part 6, but no later than August 1, 2025.

Page 6, Line 10(II)  Members of the advisory board serve at the pleasure

Page 6, Line 11of the governor. The term of appointment is three years.

Page 6, Line 12(c)  Members of the advisory board serve without

Page 6, Line 13compensation and without reimbursement for expenses.

Page 6, Line 14(d)  The advisory board shall elect a chair and vice-chair

Page 6, Line 15from among its provider and consumer members and shall meet

Page 6, Line 16as necessary at the call of the chair to perform its functions as

Page 6, Line 17specified in this part 6.

Page 6, Line 18(2)  The advisory board shall consult with the state

Page 6, Line 19department, as well as the state board as necessary, in

Page 6, Line 20implementing this part 6, including assisting the state

Page 6, Line 21department in administering and providing oversight of the

Page 6, Line 22provider stabilization fund and in leveraging the fund to obtain

Page 6, Line 23federal matching money.

Page 6, Line 24(3)  This section is repealed, effective September 1, 2031.

Page 6, Line 25Before the repeal, the committee is scheduled for review in

Page 6, Line 26accordance with section 2-3-1203.

Page 6, Line 2725.5-3-606.  Provider stabilization fund report (1)  Beginning

Page 6, Line 28September 1, 2026, and by each September 1 thereafter, the state

Page 6, Line 29department, with assistance from the advisory board, shall

Page 6, Line 30prepare and submit an annual report concerning the provider

Page 6, Line 31stabilization fund to:

Page 6, Line 32(a)  The health and human services committee of the house

Page 6, Line 33of representatives and the health and human services committee

Page 6, Line 34of the senate, or their successor committees;

Page 6, Line 35(b)  The joint budget committee;

Page 6, Line 36(c)  The governor; and

Page 6, Line 37(d)  The state board.

Page 6, Line 38(2)  At a minimum, the report must include:

Page 6, Line 39(a)  The number of low-income, uninsured individuals and

Page 6, Line 40the number of medicaid, medicare, and children's basic health

Page 6, Line 41plan enrollees served by eligible safety net providers that

Page 6, Line 42received provider stabilization payments in the immediately

Page 6, Line 43preceding fiscal year;

Page 7, Line 1(b)  The allocation of money to eligible safety net

Page 7, Line 2providers, including an itemization of the total amount of

Page 7, Line 3provider stabilization payments allocated to each eligible

Page 7, Line 4safety net provider; and

Page 7, Line 5(c)  Any other information that the state department, in

Page 7, Line 6consultation with the advisory board, deems necessary or

Page 7, Line 7appropriate.

Page 7, Line 8(3)  Notwithstanding the requirement in section 24-1-136

Page 7, Line 9(11)(a)(I), the requirement to submit the report required in this

Page 7, Line 10section continues indefinitely.

Page 7, Line 11SECTION 3.  In Colorado Revised Statutes, 2-3-1203, add

Page 7, Line 12(22)(a)(VII) as follows:

Page 7, Line 132-3-1203.  Sunset review of advisory committees - legislative

Page 7, Line 14declaration - definition - repeal. (22) (a)  The following statutory

Page 7, Line 15authorizations for the designated advisory committees will repeal on

Page 7, Line 16September 1, 2031:

Page 7, Line 17(VII)  The provider stabilization fund advisory board

Page 7, Line 18created in section 25.5-3-605.".

Page 7, Line 19Renumber succeeding sections accordingly.

Page 7, Line 20Page 15, line 26, after "Interest" insert "and, if necessary,

Page 7, Line 21principal".

Page 7, Line 22Page 15, line 27, after "section," insert "as a loan".

Page 7, Line 23Page 16, line 1, strike "25.5-4-402.4 (5.3)(a)" and substitute "25.5-3-603

Page 7, Line 24(1)".

Page 7, Line 25Page 16, strike line 4 and substitute:

Page 7, Line 26"(6) (a)  Except as provided in subsection (6)(b) of this

Page 7, Line 27section, the state treasurer shall make an interest-free loan of

Page 7, Line 28interest derived from".

Page 7, Line 29Page 16, line 7, strike "25.5-4-402.4 (5.3)(a)" and substitute "25.5-3-603

Page 7, Line 30(1)".

Page 7, Line 31Page 16, line 8, strike "(a)" and substitute "(I)".

Page 7, Line 32Page 16, line 8, strike "July" and substitute "August".

Page 7, Line 33Page 16, line 9, strike "(b)" and substitute "(II)".

Page 7, Line 34

Page 8, Line 1Page 16, line 9, strike "July" and substitute "August".

Page 8, Line 2Page 16, strike lines 10 through 19 and substitute:

Page 8, Line 3"(III)  On August 1, 2027, August 1, 2028, and August 1, 2029,

Page 8, Line 4fifteen million dollars.

Page 8, Line 5(b)  If there is an insufficient amount of interest in the

Page 8, Line 6unclaimed property trust fund to enable the state treasurer to

Page 8, Line 7credit the full amount required for a particular state fiscal

Page 8, Line 8year from interest alone, the state treasurer shall credit an

Page 8, Line 9amount of principal in the trust fund that is sufficient to enable

Page 8, Line 10the state treasurer to credit to the provider stabilization fund

Page 8, Line 11the full amount required for that state fiscal year.".

Page 8, Line 12Renumber succeeding section accordingly.

Page 8, Line 13Page 1, strike lines 102 and 103 and substitute "to make provider".

Page 8, Line 14Page 1, line 107, strike "to support the operations of the

Page 8, Line 15enterprise." and substitute "stabilize the health-care safety

Page 8, Line 16net.".