A Bill for an Act
Page 1, Line 101Concerning the establishment of long-term services and
Page 1, Line 102supports for an individual transitioning out of a
Page 1, Line 103nursing facility.
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 requires an individual being discharged from a nursing facility to be presumptively eligible for long-term services and supports under medicaid.
The bill requires the department of health care policy and financing (state department) to determine presumptive eligibility and requires county departments of human or social services (county departments) to set up the long-term services and supports for an individual being discharged from a nursing facility prior to the individual's discharge date.
The state department is required to submit an annual report to the state auditor and post the report on the state department's website detailing information about the individuals discharged from a nursing facility and the associated presumptive eligibility determinations.
The bill establishes remedial measures against a county department if the county department fails to set up long-term services and supports for the individual. The bill establishes remedial measures against a nursing facility that fails to discharge an individual on the discharge date due to a failure within the nursing facility's control or fails to cooperate in good faith with the state department to ensure long-term care services and supports are in place for the individual.
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. In Colorado Revised Statutes, add 25.5-6-315 as
Page 2, Line 3follows:
Page 2, Line 425.5-6-315. Long-term services and supports for nursing
Page 2, Line 5facility residents - discharge planning - presumptive eligibility -
Page 2, Line 6reporting - definition.
Page 2, Line 7(1) As used in this section, unless the context otherwise
Page 2, Line 8requires, "presumptive eligibility" has the meaning set forth in
Page 2, Line 9section 25.5-5-204.
Page 2, Line 10(2) (a) If the state department receives federal
Page 2, Line 11authorization pursuant to section 25.5-5-204 (2.7) and, as
Page 2, Line 12necessary, subsection (15) of this section, an individual being
Page 2, Line 13discharged from a nursing facility is presumptively eligible for
Page 2, Line 14the medical assistance program pursuant to this article 6 and
Page 2, Line 15articles 4 and 5 of this title 25.5 to receive long-term services
Page 2, Line 16and supports, including home- and community-based services,
Page 2, Line 17pursuant to this article 6 if the individual:
Page 3, Line 1(I) Is functionally eligible for long-term services and
Page 3, Line 2supports pursuant to this article 6; and
Page 3, Line 3(II) Attests to information that meets the income, assets,
Page 3, Line 4and immigration eligibility requirements for the medical
Page 3, Line 5assistance program.
Page 3, Line 6(b) The attestation required by subsection (2)(a)(II) of this
Page 3, Line 7section must be made to the state department in the manner
Page 3, Line 8prescribed by the state department at the time of the functional
Page 3, Line 9eligibility assessment required in subsection (4) of this section.
Page 3, Line 10(3) A nursing facility shall notify the state department
Page 3, Line 11within three business days of an individual who is eligible to
Page 3, Line 12transition out of a nursing facility after determining the
Page 3, Line 13individual's eligibility to transition out of the nursing facility.
Page 3, Line 14(4) (a) The state department must assess an individual
Page 3, Line 15being discharged from a nursing facility to determine whether
Page 3, Line 16the individual is functionally eligible for long-term services
Page 3, Line 17and supports pursuant to this article 6 within one business day
Page 3, Line 18after receiving notification that the individual is eligible to
Page 3, Line 19transition out of a nursing facility. A functional eligibility
Page 3, Line 20determination must be made before housing is secured for the
Page 3, Line 21individual.
Page 3, Line 22(b) If the state department determines that an individual
Page 3, Line 23is functionally eligible for long-term services and supports
Page 3, Line 24pursuant to this article 6 and subsection (4)(a) of this section,
Page 3, Line 25and the individual completed the attestation required in
Page 3, Line 26subsection (2)(a)(II) of this section, the state department shall
Page 3, Line 27determine that the individual is presumptively eligible to
Page 4, Line 1receive long-term services and supports pursuant to this
Page 4, Line 2section. The state department shall notify the county
Page 4, Line 3department that the individual is presumptively eligible.
Page 4, Line 4(c) Upon receipt of the presumptive eligibility
Page 4, Line 5determination made pursuant to subsection (4)(b) of this section
Page 4, Line 6and within three business days after receiving the notification,
Page 4, Line 7the county department must enroll the individual in long-term
Page 4, Line 8services and supports that meet the individual's needs. The
Page 4, Line 9county department shall not engage in a financial eligibility
Page 4, Line 10determination for the individual.
Page 4, Line 11(5) The individual or the individual's legal representative
Page 4, Line 12must submit an application for long-term services and supports
Page 4, Line 13to the state department within ten calendar days after the
Page 4, Line 14presumptive eligibility determination.
Page 4, Line 15(6) If an individual being discharged from a nursing
Page 4, Line 16facility is determined to be presumptively eligible for services
Page 4, Line 17through a long-term care program pursuant to this article 6,
Page 4, Line 18any prior authorization required for a service provider to bill
Page 4, Line 19for home health services rendered to the individual must be
Page 4, Line 20approved by the state department, and the necessary services
Page 4, Line 21must be in place prior to the individual's date of discharge from
Page 4, Line 22the nursing facility.
Page 4, Line 23(7) After presumptive eligibility is determined for an
Page 4, Line 24individual, the nursing facility must work with all appropriate
Page 4, Line 25entities to ensure the long-term services and supports that the
Page 4, Line 26individual requires are in place prior to the individual's date of
Page 4, Line 27discharge from the nursing facility.
Page 5, Line 1(8) The presumptive eligibility period begins on the date
Page 5, Line 2the individual is determined functionally eligible for long-term
Page 5, Line 3services and supports pursuant to this article 6 and subsection
Page 5, Line 4(4)(a) of this section and ends on the later of:
Page 5, Line 5(a) The last day of the month following the month of the
Page 5, Line 6presumptive eligibility determination if a long-term service and
Page 5, Line 7support application is not completed and submitted pursuant to
Page 5, Line 8subsection (5) of this section within ten calendar days after the
Page 5, Line 9presumptive eligibility determination; or
Page 5, Line 10(b) The last day of the month that final eligibility
Page 5, Line 11determination is made if a long-term service and support
Page 5, Line 12application is submitted pursuant to subsection (5) of this
Page 5, Line 13section within ten calendar days after the presumptive
Page 5, Line 14eligibility determination.
Page 5, Line 15(9) If it is determined that an individual is not eligible for
Page 5, Line 16medical benefits after the individual was determined to be
Page 5, Line 17eligible for services through a long-term care program
Page 5, Line 18pursuant to this article 6 based on presumptive eligibility, the
Page 5, Line 19state department shall not pursue recovery from a county
Page 5, Line 20department for the cost of medical services provided to the
Page 5, Line 21individual. The county department is not responsible for any
Page 5, Line 22federal error rate sanctions resulting from the determination.
Page 5, Line 23(10) Redetermination of eligibility for medical assistance
Page 5, Line 24must take place annually on the date the member was initially
Page 5, Line 25enrolled in the state medical assistance program.
Page 5, Line 26(11) On or before January 1, 2028, and each January 1
Page 5, Line 27thereafter, the state department shall submit a report to the
Page 6, Line 1state auditor and post the report on the state department's
Page 6, Line 2website detailing the following for the previous calendar year:
Page 6, Line 3(a) The number of individuals discharged from a nursing
Page 6, Line 4facility who were determined to be presumptively eligible for
Page 6, Line 5long-term services and supports as described in the state
Page 6, Line 6medical assistance program established pursuant to this article
Page 6, Line 76 and articles 4 and 5 of this title 25.5;
Page 6, Line 8(b) How long it took for each presumptive eligibility
Page 6, Line 9determination to be made;
Page 6, Line 10(c) How long it took to determine functional eligibility
Page 6, Line 11and financial eligibility for each individual;
Page 6, Line 12(d) For each individual, the number of days between when
Page 6, Line 13the state department notified the county department that the
Page 6, Line 14individual was functionally eligible for long-term services and
Page 6, Line 15supports and when the county department enrolled the
Page 6, Line 16individual in long-term services and supports;
Page 6, Line 17(e) The number of individuals who were determined to be
Page 6, Line 18presumptively eligible for long-term services and supports and
Page 6, Line 19discharged from a nursing facility without long-term services
Page 6, Line 20and supports in place and the reason that the necessary services
Page 6, Line 21and supports were not in place at the time of the individual's
Page 6, Line 22discharge from the nursing facility; and
Page 6, Line 23(f) A list of local support agencies, including any of the
Page 6, Line 24state-contracted independent living centers, area agency on
Page 6, Line 25aging centers, or other community support agencies, that
Page 6, Line 26provide services to the elderly, blind, or disabled community.
Page 6, Line 27(12) Upon receipt of the report submitted pursuant to
Page 7, Line 1subsection (11) of this section, the state auditor may conduct an
Page 7, Line 2audit of the state department for any delay detailed in the
Page 7, Line 3report that resulted in an individual being discharged from a
Page 7, Line 4nursing facility without long-term services and supports in
Page 7, Line 5place.
Page 7, Line 6(13) If a county department fails three times within a
Page 7, Line 7calendar year to enroll an individual in long-term services and
Page 7, Line 8supports within three business days after receiving notification
Page 7, Line 9from the state department as required by subsection (3)(c) of
Page 7, Line 10this section, the state department may transfer the
Page 7, Line 11responsibility to another agency or vendor.
Page 7, Line 12(14) (a) If a nursing facility fails to discharge an
Page 7, Line 13individual on the date of discharge due to a failure within the
Page 7, Line 14nursing facility's control or fails to cooperate in good faith
Page 7, Line 15with the state department to ensure long-term care services
Page 7, Line 16and supports are in place for the individual on the individual's
Page 7, Line 17date of discharge, the state department may issue a billing
Page 7, Line 18penalty resulting in the nursing facility's inability to bill the
Page 7, Line 19medical assistance program for up to a maximum of seven
Page 7, Line 20calendar days for the services rendered as a result of the
Page 7, Line 21delay.
Page 7, Line 22(b) The penalty described in subsection (14)(a) of this
Page 7, Line 23section does not apply if the delay was the result of factors
Page 7, Line 24beyond the nursing facility's control.
Page 7, Line 25(15) The state department is authorized to seek federal
Page 7, Line 26authorization to allow a nursing facility resident who requires
Page 7, Line 27services through a long-term care program pursuant to this
Page 8, Line 1article 6 upon discharge from a nursing facility to be
Page 8, Line 2presumptively eligible for long-term services and supports as
Page 8, Line 3described in the state medical assistance program established
Page 8, Line 4pursuant to this article 6 and articles 4 and 5 of this title 25.5.
Page 8, Line 5If federal authorization is needed to implement the
Page 8, Line 6requirements of this section, this section does not take effect
Page 8, Line 7until federal authorization is approved.
Page 8, Line 8(16) The state department shall make any necessary
Page 8, Line 9changes to the state plan waivers for home- and
Page 8, Line 10community-based service programs and any other federal
Page 8, Line 11authorizations that are authorized pursuant to this article 6 to
Page 8, Line 12comply with this section.
Page 8, Line 13(17) The state department shall satisfy the requirements
Page 8, Line 14of this section using existing resources of the state department.
Page 8, Line 15SECTION 2. Act subject to petition - effective date. This act
Page 8, Line 16takes effect at 12:01 a.m. on the day following the expiration of the
Page 8, Line 17ninety-day period after final adjournment of the general assembly (August
Page 8, Line 1812, 2026, if adjournment sine die is on May 13, 2026); except that, if a
Page 8, Line 19referendum petition is filed pursuant to section 1 (3) of article V of the
Page 8, Line 20state constitution against this act or an item, section, or part of this act
Page 8, Line 21within such period, then the act, item, section, or part will not take effect
Page 8, Line 22unless approved by the people at the general election to be held in
Page 8, Line 23November 2026 and, in such case, will take effect on the date of the
Page 8, Line 24official declaration of the vote thereon by the governor.