A Bill for an Act
Page 1, Line 101Concerning redetermination of eligibility for individuals
Page 1, Line 102enrolled in the state 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 authorizes the department of health care policy and financing (state department) to seek federal authorization to:
- Extend the timeline for member reenrollment in the state medical assistance program based on the financial eligibility for a member whose income is based solely on a fixed income source; and
- Verify a member's eligibility for reenrollment based on income and need at the same time.
The bill requires the state department to modify the questions asked to medical professionals when verifying a member's need for long-term services and supports and allows any licensed medical professional who has a bona fide physician-patient relationship with a member to complete the documentation necessary to verify a member's need for long-term services and supports.
The bill prohibits the state department from requiring new documentation for a member who transitions from receiving services in an institutional setting to receiving services in a home- and community-based setting and vice versa.
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 3SECTION 1. In Colorado Revised Statutes, 25.5-4-205, add (3)(b)(I.5)(H) as follows:
Page 2, Line 425.5-4-205. Application - verification of eligibility -
Page 2, Line 5demonstration project - rules. (3) (b) (I.5) (H) On or before July 1,
Page 2, Line 62028, the state department shall seek any necessary federal
Page 2, Line 7authorization to allow the state department to determine a
Page 2, Line 8member's eligibility for reenrollment without checking
Page 2, Line 9federally approved electronic data sources or requesting
Page 2, Line 10additional verification, if the member's income consists solely of
Page 2, Line 11social security income or other source of stable income or
Page 2, Line 12assets. The department, in consultation with medicaid members
Page 2, Line 13and advocacy groups, shall make a reasonable determination of
Page 2, Line 14what types of income and assets are considered stable or
Page 2, Line 15expected to decrease in value and assume no change in those
Page 2, Line 16income sources or assets without checking federally approved
Page 2, Line 17electronic data sources or requesting additional verification.
Page 2, Line 18On or before July 1, 2028, the state department shall seek any
Page 3, Line 1necessary federal authorization to allow the state department
Page 3, Line 2to determine a member's eligibility for reenrollment without
Page 3, Line 3requiring additional verification of the member's income or
Page 3, Line 4assets, if the member's income or assets has not changed since
Page 3, Line 5the initial verification that took place during the application process or as specified through federal authorization.
Page 3, Line 6SECTION 2. In Colorado Revised Statutes, add 25.5-6-117 as follows:
Page 3, Line 725.5-6-117. Determination of need-based services -
Page 3, Line 8professional medical information document - definition. (1) As used
Page 3, Line 9in this section, unless the context otherwise requires,
Page 3, Line 10"professional medical information document" means documented
Page 3, Line 11medical information signed by a licensed medical professional
Page 3, Line 12and used as a component of thefunctional assessment for
Page 3, Line 13long-term services and supports that verifies a member's need for long-term services and supports.
Page 3, Line 14(2) On or before December 31, 2026, the state department
Page 3, Line 15shall modify the professional medical information document
Page 3, Line 16used to assess a member's need for long-term services and
Page 3, Line 17supports to reduce the number of medical questions required in
Page 3, Line 18the documentation that are obtained from medical professionals.
Page 3, Line 19(3) A treating licensed medical professional, as defined in
Page 3, Line 20rule by the state board as it relates to home- and
Page 3, Line 21community-based services, who has a bona fide physician-patient
Page 3, Line 22relationship with a member shall sign a professional medical
Page 3, Line 23information document for the member.
Page 4, Line 2SECTION 3. Act subject to petition - effective date. This act
Page 4, Line 3takes effect at 12:01 a.m. on the day following the expiration of the
Page 4, Line 4ninety-day period after final adjournment of the general assembly; except
Page 4, Line 5that, if a referendum petition is filed pursuant to section 1 (3) of article V
Page 4, Line 6of the state constitution against this act or an item, section, or part of this
Page 4, Line 7act within such period, then the act, item, section, or part will not take
Page 4, Line 8effect unless approved by the people at the general election to be held in
Page 4, Line 9November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.