Senate Bill 25-270 Introduced

A Bill for an Act

• Page 1, Line 101Concerning nursing facility fees collected by the Colorado

• Page 1, Line 102healthcare affordability and sustainability

• Page 1, Line 103enterprise, and, in connection therewith, authorizing

• Page 1, Line 104the enterprise to provide additional services to

• Page 1, Line 105nursing facilities in exchange for the fees collected

• Page 1, Line 106and making and reducing appropriations.

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 repeals the existing nursing facility provider fee and intermediate care facility service fee, effective May 1, 2025, and provides that, beginning on May 1, 2025, and for each state fiscal year thereafter, the Colorado healthcare affordability and sustainability enterprise (CHASE) within the department of health care policy and financing will charge and collect a new healthcare affordability and sustainability nursing facility provider fee and a new healthcare affordability and sustainability intermediate care facility fee that function similarly to the repealed fees. The bill creates a facility provider fee enterprise support board within CHASE for the purpose of supporting the existing enterprise with the implementation of the healthcare affordability and sustainability nursing facility provider fee and the healthcare affordability and sustainability intermediate care facility fee. In exchange for payment of the healthcare affordability and sustainability nursing facility provider fee, CHASE will provide certain business services to nursing facility providers to sustain or increase reimbursement rates and make supplemental medicaid payments to nursing facility providers. In exchange for payment of the healthcare affordability and sustainability intermediate care facility fee, CHASE will provide certain business services to intermediate care facility providers for individuals with intellectual disabilities for the purposes of maintaining the quality and continuity of services provided by intermediate care facilities for individuals with intellectual disabilities. Because CHASE is an enterprise for purposes of the Taxpayer's Bill of Rights, its revenue does not count against the state fiscal year spending limit.

The bill also makes conforming amendments and, for clarity, renames the existing healthcare affordability and sustainability fee and healthcare affordability and sustainability fund to be the healthcare affordability and sustainability hospital provider fee and the healthcare affordability and sustainability hospital provider fee cash fund.

• Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:

• Page 2, Line 2SECTION 1.  In Colorado Revised Statutes, 25.5-4-402.4, amend

• Page 2, Line 3(2) introductory portion, (2)(a), (2)(c) introductory portion, (2)(c)(V),

• Page 2, Line 4(2)(c)(VI), (2)(d) introductory portion, (2)(e), (2)(f), (2)(g), (3)(a),

• Page 2, Line 5(3)(c)(I), (3)(d)(I), (3)(d)(II), (3)(d)(III), (3)(d)(V), (4)(b) introductory

• Page 2, Line 6portion, (4)(b)(II), (4)(b)(III), (4)(c)(I) introductory portion, (4)(c)(II)(C),

• Page 2, Line 7(4)(c)(III) introductory portion, (4)(c)(III)(E), (4)(c)(III)(F), (4)(e), (4)(f),

• Page 2, Line 8(5)(a), (5)(b) introductory portion, (5)(b)(IV) introductory portion,

• Page 3, Line 1(5)(b)(VI)(B), (5)(c)(I)(A), (5)(c)(II)(C), (5)(c)(III), (5)(c)(V), (6)(a)(I),

• Page 3, Line 2(6)(b) introductory portion, (6)(b)(II), (6)(b)(III)(A), (6)(b)(III)(B), (6)(c),

• Page 3, Line 3(7)(b), (7)(d)(I), (7)(d)(II), (7)(d)(III), (7)(d)(IX), (7)(d)(X), (7)(e)

• Page 3, Line 4introductory portion, (7)(e)(II), (7)(e)(III) introductory portion, and

• Page 3, Line 5(7)(e)(IV); amend as they exist until July 1, 2025, (2)(d)(I), (4)(a)

• Page 3, Line 6introductory portion, and (4)(g); and add (2)(c)(V.5), (2)(c)(V.7),

• Page 3, Line 7(2)(d.5), (2)(d.7), (3)(c)(III), (3)(c)(IV), (4.5), (4.7), (5.5), (5.7),

• Page 3, Line 8(6)(a)(IV), (6)(a)(V), (6)(b.5), (6)(c.5), (6)(c.7), (7)(e)(II.5), (7)(e)(II.7), (7)(e)(III.5), (7)(e)(III.7), (7)(g), and (9) as follows:

• Page 3, Line 925.5-4-402.4.  Healthcare affordability and sustainability

• Page 3, Line 10hospital provider fee - healthcare affordability and sustainability

• Page 3, Line 11nursing facility provider fee - healthcare affordability and

• Page 3, Line 12sustainability intermediate care facility fee - Colorado healthcare

• Page 3, Line 13affordability and sustainability enterprise - federal waiver - funds

• Page 3, Line 14created - reports - rules - legislative declaration - repeal.

• Page 3, Line 15(2)  Legislative declaration. The general assembly hereby finds and declares that:

• Page 3, Line 16(a)  The state and the providers of publicly funded medical

• Page 3, Line 17services, and hospitals, nursing facility providers, and intermediate

• Page 3, Line 18care facilities for individuals with intellectual disabilities in

• Page 3, Line 19particular, share a common commitment to comprehensive health-care reform;

• Page 3, Line 20(c)  This section is enacted as part of a comprehensive health-care

• Page 3, Line 21reform and is intended to provide the following services and benefits to

• Page 3, Line 22hospitals, nursing facility providers, intermediate care facilities for individuals with intellectual disabilities, and individuals:

• Page 3, Line 23(V)  Expanding access to high-quality, affordable health care for low-income and uninsured populations; and

• Page 4, Line 1(V.5)  Sustaining or increasing the reimbursement for

• Page 4, Line 2providing medical care under the state's medical assistance

• Page 4, Line 3program for nursing facility providers and making supplemental medicaid payments to nursing facility providers;

• Page 4, Line 4(V.7)  Maintaining the quality and continuity of services

• Page 4, Line 5provided by intermediate care facilities for individuals with intellectual disabilities; and

• Page 4, Line 6(VI)  Providing the additional business services specified in

• Page 4, Line 7subsection (4)(a)(IV) of this section to hospitals that pay the healthcare

• Page 4, Line 8affordability and sustainability hospital provider fee charged and

• Page 4, Line 9collected as authorized by subsection (4) of this section by the Colorado

• Page 4, Line 10healthcare affordability and sustainability enterprise created in subsection (3)(a) of this section;

• Page 4, Line 11(d)  The Colorado healthcare affordability and sustainability

• Page 4, Line 12enterprise provides business services to hospitals when, in exchange for

• Page 4, Line 13payment of healthcare affordability and sustainability hospital provider fees by hospitals, it:

• Page 4, Line 14(I)  Obtains federal matching money and returns both the

• Page 4, Line 15healthcare affordability and sustainability hospital provider fee and the

• Page 4, Line 16federal matching money to hospitals to increase reimbursement rates to

• Page 4, Line 17hospitals for providing medical care under the state medical assistance

• Page 4, Line 18program and the Colorado indigent care program and to increase the number of individuals covered by public medical assistance; and

• Page 4, Line 19(d.5)  The Colorado healthcare affordability and

• Page 4, Line 20sustainability enterprise provides business services to nursing

• Page 4, Line 21facility providers when, in exchange for payment of nursing

• Page 5, Line 1facility provider fees, it obtains federal matching money and

• Page 5, Line 2returns both the nursing facility provider fee and the federal

• Page 5, Line 3matching money to nursing facility providers to sustain or

• Page 5, Line 4increase reimbursement rates and make supplemental medicaid payments to nursing facility providers;

• Page 5, Line 5(d.7)  The Colorado healthcare affordability and

• Page 5, Line 6sustainability enterprise provides business services to

• Page 5, Line 7intermediate care facilities for individuals with intellectual

• Page 5, Line 8disabilities when, in exchange for payment of intermediate care

• Page 5, Line 9facility fees, it obtains federal matching money and returns

• Page 5, Line 10both the intermediate care facility fee and the federal

• Page 5, Line 11matching money to intermediate care facilities for individuals

• Page 5, Line 12with intellectual disabilities to sustain or increase

• Page 5, Line 13reimbursement rates and make supplemental medicaid payments to such intermediate care facilities;

• Page 5, Line 14(e)  It is necessary, appropriate, and in the best interest of the state

• Page 5, Line 15to acknowledge that by providing the business services specified in

• Page 5, Line 16subsections (2)(d)(I) and (2)(d)(II) subsections (2)(d) to (2)(d.7) of this

• Page 5, Line 17section, the Colorado healthcare affordability and sustainability enterprise

• Page 5, Line 18engages in an activity conducted in the pursuit of a benefit, gain, or livelihood and therefore operates as a business;

• Page 5, Line 19(f)  Consistent with the determination of the Colorado supreme

• Page 5, Line 20court in Nicholl v. E-470 Public Highway Authority, 896 P.2d 859 (Colo.

• Page 5, Line 211995), that the power to impose taxes is inconsistent with enterprise status

• Page 5, Line 22under section 20 of article X of the state constitution, it is the conclusion

• Page 5, Line 23of the general assembly that the healthcare affordability and sustainability

• Page 5, Line 24hospital provider fee, the healthcare affordability and

• Page 6, Line 1sustainability nursing facility provider fee, and the healthcare

• Page 6, Line 2affordability and sustainability intermediate care facility fee

• Page 6, Line 3charged and collected by the Colorado healthcare affordability and

• Page 6, Line 4sustainability enterprise is a fee are fees, not a tax taxes, because the

• Page 6, Line 5fee is fees are imposed for the specific purposes of allowing the

• Page 6, Line 6enterprise to defray the costs of providing the business services specified

• Page 6, Line 7in subsections (2)(d)(I) and (2)(d)(II) subsections (2)(d) to (2)(d.7) of

• Page 6, Line 8this section to hospitals, nursing facility providers, and

• Page 6, Line 9intermediate care facilities for individuals with intellectual

• Page 6, Line 10disabilities that pay the fee fees and is are collected at rates that are

• Page 6, Line 11reasonably calculated based on the benefits received by those hospitals, nursing facility providers, and intermediate care facilities; and

• Page 6, Line 12(g)  So long as the Colorado healthcare affordability and

• Page 6, Line 13sustainability enterprise qualifies as an enterprise for purposes of section

• Page 6, Line 1420 of article X of the state constitution, the revenues from the healthcare

• Page 6, Line 15affordability and sustainability fee fees charged and collected by the

• Page 6, Line 16enterprise are not state fiscal year spending, as defined in section

• Page 6, Line 1724-77-102 (17), or state revenues, as defined in section 24-77-103.6

• Page 6, Line 18(6)(c), and do not count against either the state fiscal year spending limit

• Page 6, Line 19imposed by section 20 of article X of the state constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I).

• Page 6, Line 20(3) Colorado healthcare affordability and sustainability

• Page 6, Line 21enterprise. (a)  The Colorado healthcare affordability and sustainability

• Page 6, Line 22enterprise referred to in this section as the "enterprise", is created. The

• Page 6, Line 23enterprise is and operates as a government-owned business within the state department for the purpose of:

• Page 6, Line 24(I)  Charging and collecting:

• Page 7, Line 1(A)  The healthcare affordability and sustainability hospital provider fee;

• Page 7, Line 2(B)  The nursing facility provider fee; and

• (C)  The intermediate care facility fee;

• Page 7, Line 3(II)  Leveraging healthcare affordability and sustainability

• Page 7, Line 4revenue from thehospital provider fee, revenue the nursing

• Page 7, Line 5facility provider fee, and the intermediate care facility fee to obtain federal matching money; and

• Page 7, Line 6(III)  Utilizing and deploying:

• Page 7, Line 7(A)  The healthcare affordability and sustainability hospital

• Page 7, Line 8provider fee revenue and federal matching money to provide the

• Page 7, Line 9business services specified in subsections (2)(d)(I) and (2)(d)(II) of this

• Page 7, Line 10section to hospitals that pay the healthcare affordability and sustainability fee;

• Page 7, Line 11(B)  The nursing facility provider fee revenue and any

• Page 7, Line 12federal matching money to provide the business services

• Page 7, Line 13specified in subsection (2)(d.5) of this section to nursing facility providers that pay the nursing facility provider fee; and

• Page 7, Line 14(C)  The intermediate care facility fee revenue and any

• Page 7, Line 15federal matching money to provide the business services

• Page 7, Line 16specified in subsection (2)(d.7) of this section to intermediate

• Page 7, Line 17care facilities for individuals with intellectual disabilities that pay the intermediate care facility fee.

• Page 7, Line 18(c) (I)  The repeal of the hospital provider fee program, as it

• Page 7, Line 19existed pursuant to section 25.5-4-402.3 before its repeal, effective July

• Page 7, Line 201, 2017, by Senate Bill 17-267, enacted in 2017, and the creation of the

• Page 7, Line 21Colorado healthcare affordability and sustainability enterprise as a new

• Page 8, Line 1enterprise to charge and collect a new healthcare affordability and

• Page 8, Line 2sustainability hospital provider fee as authorized by subsection (4) of

• Page 8, Line 3this section and provide healthcare affordability and sustainability

• Page 8, Line 4fee-funded business services to hospitals that replace and supplement

• Page 8, Line 5services previously funded by the repealed hospital provider fees is the

• Page 8, Line 6creation of a new government-owned business that provides business

• Page 8, Line 7services to hospitals as a new enterprise for purposes of section 20 of

• Page 8, Line 8article X of the state constitution, does not constitute the qualification of

• Page 8, Line 9an existing government-owned business as an enterprise for purposes of

• Page 8, Line 10section 20 of article X of the state constitution or section 24-77-103.6

• Page 8, Line 11(6)(b)(II), and, therefore, does not require or authorize adjustment of the

• Page 8, Line 12state fiscal year spending limit calculated pursuant to section 20 of article

• Page 8, Line 13X of the state constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I).

• Page 8, Line 14(III)  The repeal of the nursing facility provider fee

• Page 8, Line 15program, as it existed in section 25.5-6-203 (1) before its repeal,

• Page 8, Line 16effective May 1, 2025, by this Senate Bill 25-___, enacted in 2025,

• Page 8, Line 17and the enterprise's ability to charge and collect a new

• Page 8, Line 18healthcare affordability and sustainability nursing facility

• Page 8, Line 19provider fee as authorized by subsection (4.5) of this section and

• Page 8, Line 20provide fee-funded business services to nursing facility

• Page 8, Line 21providers that replace and supplement services previously

• Page 8, Line 22funded by the nursing facility provider fee does not constitute

• Page 8, Line 23creation of a new enterprise or the qualification of an existing

• Page 8, Line 24government-owned business as an enterprise for purposes of

• Page 8, Line 25section 20 of article X of the state constitution, section

• Page 8, Line 2624-77-103.6 (6)(b)(II), or section 24-77-108, and, therefore, does

• Page 9, Line 1not require or authorize adjustment of the state fiscal year

• Page 9, Line 2spending limit calculated pursuant to section 20 of article X of

• Page 9, Line 3the state constitution or the excess state revenues cap, as

• Page 9, Line 4defined in section 24-77-103.6 (6)(b)(I), and does not require voter approval.

• Page 9, Line 5(IV)  The repeal of the intermediate care facility service

• Page 9, Line 6fee program, as it existed in section 25.5-6-204 (1)(c)(I) before its

• Page 9, Line 7repeal, effective May 1, 2025, by this Senate Bill 25-___, enacted

• Page 9, Line 8in 2025, and the enterprise's ability to charge and collect a new

• Page 9, Line 9healthcare affordability and sustainability intermediate care

• Page 9, Line 10facility fee as authorized by subsection (4.7) of this section and

• Page 9, Line 11provide fee-funded business services to intermediate care

• Page 9, Line 12facilities for individuals with intellectual disabilities that

• Page 9, Line 13replace and supplement services previously funded by the

• Page 9, Line 14intermediate care facility service fee does not constitute

• Page 9, Line 15creation of a new enterprise or the qualification of an existing

• Page 9, Line 16government-owned business as an enterprise for purposes of

• Page 9, Line 17section 20 of article X of the state constitution, section

• Page 9, Line 1824-77-103.6 (6)(b)(II), or section 24-77-108, and, therefore, does

• Page 9, Line 19not require or authorize adjustment of the state fiscal year

• Page 9, Line 20spending limit calculated pursuant to section 20 of article X of

• Page 9, Line 21the state constitution or the excess state revenues cap, as

• Page 9, Line 22defined in section 24-77-103.6 (6)(b)(I), and does not require voter approval.

• Page 9, Line 23(d)  The enterprise's primary powers and duties are:

• (I)  To charge and collect:

• Page 9, Line 24(A)  The healthcare affordability and sustainability hospital provider fee as specified in subsection (4) of this section;

• Page 10, Line 1(B)  The nursing facility provider fee as specified in subsection (4.5) of this section; and

• Page 10, Line 2(C)  The intermediate care facility fee as specified in subsection (4.7) of this section;

• Page 10, Line 3(II)  To leverage healthcare affordability and sustainability

• Page 10, Line 4revenue from the hospital provider fee, revenue collected the

• Page 10, Line 5nursing facility provider fee, and the intermediate care facility

• Page 10, Line 6fee to obtain federal matching money, working with or through the state

• Page 10, Line 7department and the state board to the extent required by federal law or otherwise necessary;

• Page 10, Line 8(III)  To expend:

• Page 10, Line 9(A)  healthcare affordability and sustainability Hospital provider

• Page 10, Line 10fee revenue, matching federal money, and any other money from the

• Page 10, Line 11healthcare affordability and sustainability hospital provider fee cash fund as specified in subsections (4) and (5) of this section;

• Page 10, Line 12(B)  Nursing facility provider fee revenue, matching

• Page 10, Line 13federal money, and any other money from the nursing facility

• Page 10, Line 14provider fee cash fund as specified in subsection (5.5) of this section; and

• Page 10, Line 15(C)  Intermediate care facility fee revenue, matching

• Page 10, Line 16federal money, and any other money from the intermediate care

• Page 10, Line 17facility fee cash fund as specified in subsection (5.7) of this section;

• Page 10, Line 18(V)  To enter into agreements with the state department to the

• Page 10, Line 19extent necessary to collect and expend healthcare affordability and

• Page 10, Line 20sustainability revenue from thehospital provider fee, revenue the

• Page 11, Line 1nursing facility provider fee, and the intermediate care facility fee;

• Page 11, Line 2(4) Healthcare affordability and sustainability hospital

• Page 11, Line 3provider fee. (a)  For the fiscal year commencing July 1, 2017, and for

• Page 11, Line 4each fiscal year thereafter, the enterprise is authorized to charge and

• Page 11, Line 5collect a healthcare affordability and sustainability hospital provider

• Page 11, Line 6fee, as described in 42 CFR 433.68 (b), on outpatient and inpatient

• Page 11, Line 7services provided by all licensed or certified hospitals referred to in this

• Page 11, Line 8section as "hospitals", for the purpose of obtaining federal financial

• Page 11, Line 9participation under the state medical assistance program as described in

• Page 11, Line 10this article 4 and articles 5 and 6 of this title 25.5 referred to in this

• Page 11, Line 11section as the "state medical assistance program", and the Colorado

• Page 11, Line 12indigent care program described in part 1 of article 3 of this title 25.5,

• Page 11, Line 13referred to in this section as the "Colorado indigent care program". If the

• Page 11, Line 14amount of healthcare affordability and sustainability hospital provider

• Page 11, Line 15fee revenue collected exceeds the federal net patient revenue-based limit

• Page 11, Line 16on the amount of such fee revenue that may be collected, requiring

• Page 11, Line 17repayment to the federal government of excess federal matching money

• Page 11, Line 18received, hospitals that received such excess federal matching money

• Page 11, Line 19shall be responsible for repaying the excess federal money and any

• Page 11, Line 20associated federal penalties to the federal government. The enterprise

• Page 11, Line 21shall use the healthcare affordability and sustainability hospital provider fee revenue to:

• Page 11, Line 22(b)  The enterprise shall recommend for approval and

• Page 11, Line 23establishment by the state board the amount of the healthcare affordability

• Page 11, Line 24and sustainability hospital provider fee that it intends to charge and

• Page 11, Line 25collect. The state board must establish the final amount of the fee by rules

• Page 12, Line 1promulgated in accordance with article 4 of title 24. The state board shall

• Page 12, Line 2not establish any amount that exceeds the federal limit for such fees. The

• Page 12, Line 3state board may deviate from the recommendations of the enterprise, but

• Page 12, Line 4shall express in writing the reasons for any deviations. In establishing the

• Page 12, Line 5amount of the fee and in promulgating the rules governing the fee, the state board shall:

• Page 12, Line 6(II)  Establish the amount of the healthcare affordability and

• Page 12, Line 7sustainability hospital provider fee so that the amount collected from

• Page 12, Line 8the fee and federal matching funds associated with the fee are sufficient

• Page 12, Line 9to pay for the items described in subsection (4)(a) of this section, but

• Page 12, Line 10nothing in this subsection (4)(b)(II) requires the state board to increase the fee above the amount recommended by the enterprise; and

• Page 12, Line 11(III)  For the 2017-18 fiscal year, establish the amount of the

• Page 12, Line 12healthcare affordability and sustainability hospital provider fee so that

• Page 12, Line 13the amount collected from the fee is approximately equal to the sum of

• Page 12, Line 14the amounts of the appropriations specified for the fee in the general

• Page 12, Line 15appropriation act, Senate Bill 17-254, enacted in 2017, and any other supplemental appropriation act.

• Page 12, Line 16(c) (I)  In accordance with the redistributive method set forth in 42

• Page 12, Line 17CFR 433.68 (e)(1) and (e)(2), the enterprise, acting in concert with or

• Page 12, Line 18through an agreement with the state department if required by federal law,

• Page 12, Line 19may seek a waiver from the broad-based healthcare affordability and

• Page 12, Line 20sustainability hospital provider fee requirement or the uniform

• Page 12, Line 21healthcare affordability and sustainability hospital provider fee

• Page 12, Line 22requirement, or both. In addition, the enterprise, acting in concert with or

• Page 12, Line 23through an agreement with the state department if required by federal law,

• Page 12, Line 24shall seek any federal waiver necessary to fund and, in cooperation with

• Page 13, Line 1the state department and hospitals, support the implementation of a

• Page 13, Line 2health-care delivery system reform incentive payments program as

• Page 13, Line 3described in subsection (8) of this section. Subject to federal approval and

• Page 13, Line 4to minimize the financial impact on certain hospitals, the enterprise may

• Page 13, Line 5exempt from payment of the healthcare affordability and sustainability

• Page 13, Line 6hospital provider fee certain types of hospitals, including but not limited to:

• Page 13, Line 7(II)  In determining whether a hospital may be excluded, the enterprise shall use one or more of the following criteria:

• Page 13, Line 8(C)  A hospital whose inclusion or exclusion would not

• Page 13, Line 9significantly affect the net benefit to hospitals paying the healthcare affordability and sustainability hospital provider fee; or

• Page 13, Line 10(III)  The enterprise may reduce the amount of the healthcare

• Page 13, Line 11affordability and sustainability hospital provider fee for certain

• Page 13, Line 12hospitals to obtain federal approval and to minimize the financial impact

• Page 13, Line 13on certain hospitals. In determining for which hospitals the enterprise may

• Page 13, Line 14reduce the amount of the healthcare affordability and sustainability

• Page 13, Line 15hospital provider fee, the enterprise shall use one or more of the following criteria:

• Page 13, Line 16(E)  If the hospital paid a reduced healthcare affordability and

• Page 13, Line 17sustainability hospital provider fee, the reduced fee would not

• Page 13, Line 18significantly affect the net benefit to hospitals paying the healthcare affordability and sustainability fee; or

• Page 13, Line 19(F)  The hospital is required not to pay a reduced healthcare

• Page 13, Line 20affordability and sustainability hospital provider fee as a condition of federal approval.

• Page 13, Line 21(e) (I)  The enterprise shall establish policies on the calculation,

• Page 14, Line 1assessment, and timing of the healthcare affordability and sustainability

• Page 14, Line 2hospital provider fee. The enterprise shall assess the healthcare

• Page 14, Line 3affordability and sustainability hospital provider fee on a schedule to

• Page 14, Line 4be set by the enterprise board as provided in subsection (7)(d) of this

• Page 14, Line 5section. The periodic healthcare affordability and sustainability hospital

• Page 14, Line 6provider fee payments from a hospital and the enterprise's

• Page 14, Line 7reimbursement to the hospital under subsections (5)(b)(I) and (5)(b)(II)

• Page 14, Line 8of this section are due as nearly simultaneously as feasible; except that the

• Page 14, Line 9enterprise's reimbursement to the hospital is due no more than two days

• Page 14, Line 10after the periodic healthcare affordability and sustainability hospital

• Page 14, Line 11provider fee payment is received from the hospital. The healthcare

• Page 14, Line 12affordability and sustainability hospital provider fee must be imposed

• Page 14, Line 13on each hospital even if more than one hospital is owned by the same

• Page 14, Line 14entity. The fee must be prorated and adjusted for the expected volume of service for any year in which a hospital opens or closes.

• Page 14, Line 15(II)  The enterprise is authorized to refund any unused portion of

• Page 14, Line 16the healthcare affordability and sustainability hospital provider fee. For

• Page 14, Line 17any portion of the healthcare affordability and sustainability hospital

• Page 14, Line 18provider fee that has been collected by the enterprise but for which the

• Page 14, Line 19enterprise has not received federal matching funds, the enterprise shall

• Page 14, Line 20refund back to the hospital that paid the fee the amount of that portion of the fee within five business days after the fee is collected.

• Page 14, Line 21(III)  The enterprise shall establish requirements for the reports that

• Page 14, Line 22hospitals must submit to the enterprise to allow the enterprise to calculate

• Page 14, Line 23the amount of the healthcare affordability and sustainability hospital

• Page 14, Line 24provider fee. Notwithstanding the provisions of part 2 of article 72 of

• Page 14, Line 25title 24 or subsection (7)(f) of this section, information provided to the

• Page 15, Line 1enterprise pursuant to this section is confidential and is not a public

• Page 15, Line 2record. Nonetheless, the enterprise may prepare and release summaries of the reports to the public.

• Page 15, Line 3(f)  A hospital shall not include any amount of the healthcare

• Page 15, Line 4affordability and sustainability hospital provider fee as a separate line item in its billing statements.

• Page 15, Line 5(g)  The state board shall promulgate any rules pursuant to the

• Page 15, Line 6"State Administrative Procedure Act", article 4 of title 24, necessary for

• Page 15, Line 7the administration and implementation of this section. Prior to submitting

• Page 15, Line 8any proposed rules concerning the administration or implementation of

• Page 15, Line 9the healthcare affordability and sustainability hospital provider fee to

• Page 15, Line 10the state board, the enterprise shall consult with the state board on the proposed rules as specified in subsection (7)(d) of this section.

• Page 15, Line 11(4.5) Healthcare affordability and sustainability nursing

• Page 15, Line 12facility provider fee. (a)  Beginning on May 1, 2025, the enterprise

• Page 15, Line 13is authorized to charge and collect a healthcare affordability

• Page 15, Line 14and sustainability nursing facility provider fee on health-care

• Page 15, Line 15items or services provided by nursing facility providers for the

• Page 15, Line 16purpose of obtaining federal financial participation under the

• Page 15, Line 17state medical assistance program as described in this article 4

• Page 15, Line 18and articles 5 and 6 of this title 25.5. The enterprise shall use

• Page 15, Line 19the nursing facility provider fee revenue to provide a business

• Page 15, Line 20service to nursing facility providers by sustaining or increasing

• Page 15, Line 21reimbursement for providing medical care under the state

• Page 15, Line 22medical assistance program for nursing facility providers and

• Page 15, Line 23making supplemental medicaid payments to nursing facility

• Page 15, Line 24providers, as specified by the priority of the uses of the nursing

• Page 16, Line 1facility provider fee revenue set forth in subsection (5.5)(b) of this section.

• Page 16, Line 2(b)  The enterprise shall recommend for approval and

• Page 16, Line 3establishment by the state board the amount of the nursing

• Page 16, Line 4facility provider fee that it intends to charge and collect. The

• Page 16, Line 5state board must establish the final amount of the fee by rule.

• Page 16, Line 6The state board shall not establish any amount that exceeds

• Page 16, Line 7the federal limit for such fees. The state board may deviate

• Page 16, Line 8from the recommendations of the enterprise, but shall express

• Page 16, Line 9in writing the reasons for any deviations. In establishing the

• Page 16, Line 10amount of the fee and in promulgating the rules governing the fee, the state board shall:

• Page 16, Line 11(I)  Consider recommendations of the enterprise; and

• Page 16, Line 12(II)  Establish the amount of the nursing facility provider

• Page 16, Line 13fee so that the amount collected from the fee and federal

• Page 16, Line 14matching funds associated with the fee are sufficient to pay for

• Page 16, Line 15the items described in subsection (4.5)(a) of this section, but

• Page 16, Line 16nothing in this subsection (4.5)(b)(II) requires the state board to

• Page 16, Line 17increase the fee above the amount recommended by the enterprise.

• Page 16, Line 18(c)  The enterprise shall not charge or collect the nursing

• Page 16, Line 19facility provider fee in the absence of the federal government's

• Page 16, Line 20approval of a state medicaid plan amendment authorizing

• Page 16, Line 21federal financial participation for the nursing facility provider

• Page 16, Line 22fee. The enterprise may alter the process prescribed in this

• Page 16, Line 23subsection (4.5) to the extent necessary to meet federal

• Page 16, Line 24requirements and to obtain federal approval. The enterprise

• Page 17, Line 1may lower the amount of the nursing facility provider fee

• Page 17, Line 2charged to certain nursing facility providers to meet the

• Page 17, Line 3requirements of 42 CFR 433.68 (e) and to obtain federal approval.

• Page 17, Line 4(d) (I)  In accordance with the redistributive method set

• Page 17, Line 5forth in 42 CFR 433.68 (e)(1) and (e)(2), the enterprise, acting in

• Page 17, Line 6concert with or through an agreement with the state

• Page 17, Line 7department if required by federal law, may seek a waiver from

• Page 17, Line 8the broad-based nursing facility provider fee requirement or the uniform nursing facility provider fee requirement, or both.

• Page 17, Line 9(II)  Subject to federal approval and to minimize the

• Page 17, Line 10financial impact on certain nursing facility providers, the

• Page 17, Line 11enterprise may exempt from payment of the nursing facility

• Page 17, Line 12provider fee certain types of nursing provider facilities, including but not limited to:

• Page 17, Line 13(A)  A facility operated as a continuing care retirement

• Page 17, Line 14community that provides a continuum of services by one

• Page 17, Line 15operational entity providing independent living services,

• Page 17, Line 16assisted living services, and skilled nursing care on a single,

• Page 17, Line 17contiguous campus. Assisted living services include an assisted

• Page 17, Line 18living residence as defined in section 25-27-102 or a facility that

• Page 17, Line 19provides assisted living services on-site, twenty-four hours per day, seven days per week.

• Page 17, Line 20(B)  A skilled nursing facility owned and operated by the state;

• Page 17, Line 21(C)  A nursing facility that is a distinct part of a facility

• Page 17, Line 22that is licensed as a general acute care hospital; and

• (D)  A facility that has forty-five or fewer licensed beds.

• Page 18, Line 1(e) (I)  The enterprise shall establish policies on the

• Page 18, Line 2calculation, assessment, and timing of the nursing facility

• Page 18, Line 3provider fee. The enterprise shall assess the nursing facility

• Page 18, Line 4provider fee on a monthly basis. The nursing facility provider

• Page 18, Line 5fee payments from a nursing facility provider and the

• Page 18, Line 6enterprise's reimbursement and supplemental payments to the

• Page 18, Line 7nursing facility provider under subsection (5.5)(b) of this section

• Page 18, Line 8are due as nearly simultaneously as feasible; except that the

• Page 18, Line 9enterprise's reimbursement and supplemental payments to the

• Page 18, Line 10nursing facility provider are due no more than fifteen days

• Page 18, Line 11after the nursing facility provider fee payment is received from the nursing facility provider.

• Page 18, Line 12(II)  The enterprise shall establish requirements for the

• Page 18, Line 13reports that nursing facility providers must submit to the

• Page 18, Line 14enterprise to allow the enterprise to calculate the amount of

• Page 18, Line 15the nursing facility provider fee, including a requirement that

• Page 18, Line 16each nursing facility provider report annually its total number

• Page 18, Line 17of days of care provided to nonmedicare residents.

• Page 18, Line 18Notwithstanding part 2 of article 72 of title 24 or subsection

• Page 18, Line 19(7)(f) of this section, information provided to the enterprise

• Page 18, Line 20pursuant to this subsection (4.5)(e)(II) is confidential and is not

• Page 18, Line 21a public record. Nonetheless, the enterprise may prepare and release summaries of the reports to the public.

• Page 18, Line 22(f)  A nursing facility provider shall not include any

• Page 18, Line 23amount of the nursing facility provider fee as a separate line

• Page 18, Line 24item in its billing statements.

• Page 19, Line 1(g) (I)  The state board shall adopt any rules pursuant to

• Page 19, Line 2the "State Administrative Procedure Act", article 4 of title 24,

• Page 19, Line 3necessary for the administration and implementation of this

• Page 19, Line 4section. Prior to submitting any proposed rules concerning the

• Page 19, Line 5administration or implementation of the nursing facility

• Page 19, Line 6provider fee to the state board, the enterprise shall consult

• Page 19, Line 7with the state board on the proposed rules as specified in subsection (7)(g) of this section.

• Page 19, Line 8(4.7) Healthcare affordability and sustainability intermediate

• Page 19, Line 9care facility fee. (a)  Beginning on May 1, 2025, the enterprise is

• Page 19, Line 10authorized to charge and collect a healthcare affordability

• Page 19, Line 11and sustainability intermediate care facility fee on both

• Page 19, Line 12privately owned and state-operated intermediate care facilities

• Page 19, Line 13for individuals with intellectual disabilities for the purpose of

• Page 19, Line 14maintaining the quality and continuity of services provided by

• Page 19, Line 15intermediate care facilities for individuals with intellectual

• Page 19, Line 16disabilities. The enterprise shall use the intermediate care

• Page 19, Line 17facility fee revenue to provide a business service to such

• Page 19, Line 18intermediate care facilities by sustaining or increasing

• Page 19, Line 19reimbursement to such facilities, as specified in subsection(5.7)(b) of this section.

• Page 19, Line 20(b)  The enterprise shall recommend for approval and

• Page 19, Line 21establishment by the state board the amount of the

• Page 19, Line 22intermediate care facility fee that it intends to charge and

• Page 19, Line 23collect, which must not exceed five percent of the total costs

• Page 19, Line 24incurred by all intermediate care facilities for the fiscal year

• Page 19, Line 25in which the fee is charged. The state board must establish the

• Page 20, Line 1final amount of the fee by rule. The state board shall not

• Page 20, Line 2establish any amount that exceeds the federal limit for such

• Page 20, Line 3fees. The state board may deviate from the recommendations of

• Page 20, Line 4the enterprise, but shall express in writing the reasons for any deviations.

• Page 20, Line 5(c)  The enterprise may alter the process prescribed in this

• Page 20, Line 6subsection (4.7) to the extent necessary to meet federal requirements.

• Page 20, Line 7(d) (I)  The enterprise shall establish policies on the

• Page 20, Line 8calculation, assessment, and timing of the intermediate care facility fee.

• Page 20, Line 9(II)  The enterprise shall establish requirements for the

• Page 20, Line 10reports that intermediate care facilities must submit to the

• Page 20, Line 11enterprise to allow the enterprise to calculate the amount of

• Page 20, Line 12the intermediate care facility fee. Notwithstanding part 2 of

• Page 20, Line 13article 72 of title 24 or subsection (7)(f) of this section,

• Page 20, Line 14information provided to the enterprise pursuant to this

• Page 20, Line 15subsection (4.7)(d)(II) is confidential and is not a public record.

• Page 20, Line 16Nonetheless, the enterprise may prepare and release summaries of the reports to the public.

• Page 20, Line 17(e)  The state board shall adopt any rules pursuant to the

• Page 20, Line 18"State Administrative Procedure Act", article 4 of title 24,

• Page 20, Line 19necessary for the administration and implementation of this

• Page 20, Line 20section. Prior to submitting any proposed rules concerning the

• Page 20, Line 21administration or implementation of the intermediate care

• Page 20, Line 22facility fee to the state board, the enterprise shall consult

• Page 20, Line 23with the state board on the proposed rules as specified in subsection (7)(g) of this section.

• Page 21, Line 1(5) Healthcare affordability and sustainability hospital

• Page 21, Line 2provider fee cash fund. (a) (I) Any healthcare affordability and

• Page 21, Line 3sustainability hospital provider fee collected pursuant to this section

• Page 21, Line 4by the enterprise must be transmitted to the state treasurer, who shall

• Page 21, Line 5credit the fee to the healthcare affordability and sustainability hospital

• Page 21, Line 6provider fee cash fund, which fund is hereby created. and referred to in

• Page 21, Line 7this section as the "fund". The state treasurer shall credit all interest and

• Page 21, Line 8income derived from the deposit and investment of money in the

• Page 21, Line 9hospital provider fee cash fund to the fund. The state treasurer shall

• Page 21, Line 10invest any money in the hospital provider fee cash fund not expended

• Page 21, Line 11for the purposes specified in subsection (5)(b) of this section as provided

• Page 21, Line 12by law. Money in the hospital provider fee cash fund shall not be

• Page 21, Line 13transferred to any other fund and shall not be used for any purpose other

• Page 21, Line 14than the purposes specified in this subsection (5) and in subsection (4) of this section.

• Page 21, Line 15(II) (A)  The fund created in this subsection (5)(a) was

• Page 21, Line 16renamed as the healthcare affordability and sustainability

• Page 21, Line 17hospital provider fee cash fund in this Senate Bill 25-___,

• Page 21, Line 18enacted in 2025. For purposes of the annual general

• Page 21, Line 19appropriation acts for the 2024-25 and 2025-26 state fiscal years,

• Page 21, Line 20the cash funds appropriations made to the department of health

• Page 21, Line 21care policy and financing from the healthcare affordability

• Page 21, Line 22and sustainability fee cash fund, as the fund was named prior to

• Page 21, Line 23the enactment of this Senate Bill 25-___, enacted in 2025, are

• Page 21, Line 24from the healthcare affordability and sustainability hospital

• Page 21, Line 25provider fee cash fund, as renamed by this Senate Bill 25-___, enacted in 2025.

• Page 22, Line 1(B)  This subsection (5)(a)(II) is repealed, effective July 1, 2027.

• Page 22, Line 2(b)  All money in the hospital provider fee cash fund is subject

• Page 22, Line 3to federal matching as authorized under federal law and, subject to annual

• Page 22, Line 4appropriation by the general assembly, shall be expended by the enterprise for the following purposes:

• Page 22, Line 5(IV)  Subject to available revenue from the healthcare affordability

• Page 22, Line 6and sustainability hospital provider fee and federal matching funds, to expand eligibility for public medical assistance by:

• Page 22, Line 7(VI)  To pay the enterprise's actual administrative costs of

• Page 22, Line 8implementing and administering this section, including but not limited to the following costs:

• Page 22, Line 9(B)  The enterprise's actual costs related to implementing and

• Page 22, Line 10maintaining the healthcare affordability and sustainability hospital

• Page 22, Line 11provider fee, including personal services, operating, and consulting expenses;

• Page 22, Line 12(c) ARPA home- and community-based services account.

• Page 22, Line 13(I) (A)  There is created the "ARPA home- and community-based services

• Page 22, Line 14account" within the hospital provider fee cash fund, referred to in this

• Page 22, Line 15subsection (5)(c) as the "ARPA account". Notwithstanding any other

• Page 22, Line 16provision of this section to the contrary, money in the ARPA account as

• Page 22, Line 17a result of fund savings and federal matching dollars must be used in

• Page 22, Line 18accordance with section 9817 of the federal "American Rescue Plan Act

• Page 22, Line 19of 2021", Pub.L. 117-2, as amended, referred to in this section as

• Page 22, Line 20"ARPA", to implement or supplement the implementation of home- and

• Page 22, Line 21community-based services under the medical assistance program pursuant to the provisions of part 18 of article 6 of this title 25.5.

• Page 23, Line 1(II) (C)  If the fund savings due to the enhanced federal match

• Page 23, Line 2under ARPA is less than the amount transferred to the ARPA account

• Page 23, Line 3under subsection (5)(c)(II)(A) of this section, then the state department

• Page 23, Line 4shall notify the state treasurer of the amount by which the transfer

• Page 23, Line 5exceeds the savings. The state treasurer shall transfer this amount from the ARPA account to the hospital provider fee cash fund.

• Page 23, Line 6(III)  The state treasurer shall credit all interest and income derived

• Page 23, Line 7from the money in the ARPA account to the hospital provider fee cash fund.

• Page 23, Line 8(V)  Money in the ARPA account remains in the ARPA account

• Page 23, Line 9until the end of the spending period authorized under ARPA, at which

• Page 23, Line 10time money remaining in the ARPA account becomes part of the hospital provider fee cash fund.

• Page 23, Line 11(5.5) Healthcare affordability and sustainability nursing

• Page 23, Line 12facility provider fee cash fund. (a)  All healthcare affordability

• Page 23, Line 13and sustainability nursing provider fees collected pursuant to

• Page 23, Line 14this section by the enterprise must be transmitted to the state

• Page 23, Line 15treasurer, who shall credit the fee to the healthcare

• Page 23, Line 16affordability and sustainability nursing facility provider fee

• Page 23, Line 17cash fund, which fund is created. The state treasurer shall

• Page 23, Line 18credit all interest and income derived from the deposit and

• Page 23, Line 19investment of money in the nursing facility provider fee cash

• Page 23, Line 20fund to the nursing facility provider fee cash fund. The state

• Page 23, Line 21treasurer shall invest any money in the nursing facility

• Page 23, Line 22provider fee cash fund not expended for the purposes specified in

• Page 23, Line 23subsections (4.5)(a) and (5.5)(b) of this section as provided by law.

• Page 24, Line 1Money in the nursing facility provider fee cash fund shall not

• Page 24, Line 2be transferred to any other fund and shall not be used for any

• Page 24, Line 3purpose other than the purposes specified in this subsection (5.5) and in subsection (4.5)(a) of this section.

• Page 24, Line 4(b)  All money in the nursing facility provider fee cash

• Page 24, Line 5fund is subject to federal matching as authorized under federal

• Page 24, Line 6law and, subject to annual appropriation by the general

• Page 24, Line 7assembly, must be expended by the enterprise for the following purposes:

• Page 24, Line 8(I) (A)  To pay the administrative costs of implementing this subsection (5.5) and subsection (4.5) of this section;

• Page 24, Line 9(B)  To satisfy settlements or judgments resulting from nursing facility provider reimbursement appeals; and

• Page 24, Line 10(C)  To pay a nursing facility provider a supplemental

• Page 24, Line 11medicaid payment for care and services rendered to medicaid

• Page 24, Line 12residents to offset payment of the nursing facility provider fee.

• Page 24, Line 13The enterprise, in consultation with the state department, shall

• Page 24, Line 14compute this payment annually, beginning on May 1, 2025, and each July 1 thereafter.

• Page 24, Line 15(II)  After the payment of the amounts described in

• Page 24, Line 16subsection (5.5)(b)(I) of this section, to pay the supplemental

• Page 24, Line 17medicaid payments for acuity or case-mix of residents

• Page 24, Line 18established under section 25.5-6-202 (2), prior to its repeal on

• Page 24, Line 19July 1, 2026, or as provided in the rules adopted by the state

• Page 24, Line 20board pursuant to section 25.5-6-202 (10) and (14)(a), in

• Page 24, Line 21consultation with the enterprise as provided in subsection

• Page 24, Line 22(7)(g)(IV) of this section;

• Page 25, Line 1(III)  After the payment of the amounts described in

• Page 25, Line 2subsections (5.5)(b)(I) and (5.5)(b)(II) of this section, to pay

• Page 25, Line 3supplemental medicaid payments based upon performance to

• Page 25, Line 4those nursing facility providers that provide services that

• Page 25, Line 5result in better care and higher quality of life for their

• Page 25, Line 6residents. The enterprise, in consultation with the state board,

• Page 25, Line 7shall determine the payment amount based upon performance

• Page 25, Line 8measures established in rules adopted by the state board in the

• Page 25, Line 9domains of quality of life, quality of care, and facility

• Page 25, Line 10management. During each state fiscal year, the enterprise may

• Page 25, Line 11discontinue the supplemental medicaid payment established

• Page 25, Line 12pursuant to this subsection (5.5)(b)(III) to any nursing facility

• Page 25, Line 13provider that fails to comply with the established performance

• Page 25, Line 14measures during the state fiscal year, and the enterprise may

• Page 25, Line 15initiate the supplemental medicaid payment established pursuant

• Page 25, Line 16to this subsection (5.5)(b)(III) to any nursing facility provider

• Page 25, Line 17that comes into compliance with the established performance measures during the state fiscal year.

• Page 25, Line 18(IV) (A)  After the payment of the amounts described in

• Page 25, Line 19subsections (5.5)(b)(I) to (5.5)(b)(III) of this section, to pay the

• Page 25, Line 20supplemental medicaid payments to nursing facility providers

• Page 25, Line 21that serve residents who have moderate to very severe mental

• Page 25, Line 22health conditions, dementia diseases and related disabilities, or

• Page 25, Line 23acquired brain injury. The enterprise, in consultation with the

• Page 25, Line 24state department, shall compute this payment annually, beginning on May 1, 2025, and each July 1 thereafter.

• Page 25, Line 25(B)  If the enterprise determines, in consultation with the

• Page 26, Line 1state department, that the case-mix reimbursement described in

• Page 26, Line 2subsection (5.5)(b)(II) of this section includes a factor for

• Page 26, Line 3nursing facility providers that serve residents with severe

• Page 26, Line 4dementia diseases and related disabilities or acquired brain

• Page 26, Line 5injury, the enterprise may eliminate this supplemental medicaid

• Page 26, Line 6payment to those nursing facility providers that serve residents

• Page 26, Line 7with severe dementia diseases and related disabilities or acquired brain injury.

• Page 26, Line 8(V)  After the payment of the amounts described in

• Page 26, Line 9subsections (5.5)(b)(I) to (5.5)(b)(IV) of this section, to pay the

• Page 26, Line 10supplemental medicaid payments for the amount of the

• Page 26, Line 11aggregate statewide average per diem rate of patient payment

• Page 26, Line 12established under section 25.5-6-202 (9), prior to its repeal on

• Page 26, Line 13July 1, 2026, or as provided in the rules adopted by the state

• Page 26, Line 14board pursuant to section 25.5-6-202 (10) and (14)(a), in

• Page 26, Line 15consultation with the enterprise as provided in subsection(7)(g)(IV) of this section.

• Page 26, Line 16(5.7) Healthcare affordability and sustainability intermediate

• Page 26, Line 17care facility fee cash fund. (a)  All healthcare affordability and

• Page 26, Line 18sustainability intermediate care facility fees collected

• Page 26, Line 19pursuant to this section by the enterprise must be transmitted

• Page 26, Line 20to the state treasurer, who shall credit the fee to the

• Page 26, Line 21healthcare affordability and sustainability intermediate care

• Page 26, Line 22facility fee cash fund, which fund is created. The state

• Page 26, Line 23treasurer shall credit all interest and income derived from the

• Page 26, Line 24deposit and investment of money in the intermediate care

• Page 26, Line 25facility fee cash fund to the intermediate care facility cash

• Page 27, Line 1fund. The state treasurer shall invest any money in the

• Page 27, Line 2intermediate care facility fee cash fund not expended for the

• Page 27, Line 3purposes specified in subsections (4.7)(a) and (5.7)(b) of this

• Page 27, Line 4section as provided by law. Money in the intermediate care

• Page 27, Line 5facility fee cash fund shall not be transferred to any other

• Page 27, Line 6fund and shall not be used for any purpose other than the

• Page 27, Line 7purposes specified in this subsection (5.7) and in subsection (4.7)(a) of this section.

• Page 27, Line 8(b)  All money in the intermediate care facility fee cash

• Page 27, Line 9fund is subject to federal matching as authorized under federal

• Page 27, Line 10law and, subject to annual appropriation by the general

• Page 27, Line 11assembly, must be expended by the enterprise for the following purposes:

• Page 27, Line 12(I)  To pay the administrative costs of implementing this subsection (5.7) and subsection (4.7) of this section; and

• Page 27, Line 13(II)  To supplement reimbursements to intermediate care

• Page 27, Line 14facilities for individuals with intellectual disabilities as

• Page 27, Line 15provided in section 25.5-6-204. The enterprise, in consultation

• Page 27, Line 16with the state department, shall compute this payment annually, beginning on May 1, 2025, and each July 1 thereafter.

• Page 27, Line 17(6) Appropriations. (a) (I)  Except as otherwise provided in

• Page 27, Line 18subsection (6)(b)(I.5) or (6)(b)(I.7) of this section, the healthcare

• Page 27, Line 19affordability and sustainability hospital provider fee is to supplement,

• Page 27, Line 20not supplant, general fund appropriations to support hospital

• Page 27, Line 21reimbursements. General fund appropriations for hospital reimbursements

• Page 27, Line 22shall be maintained at the level of appropriations in the medical services

• Page 27, Line 23premium line item made for the fiscal year commencing July 1, 2008;

• Page 28, Line 1except that general fund appropriations for hospital reimbursements may

• Page 28, Line 2be reduced if an index of appropriations to other providers shows that

• Page 28, Line 3general fund appropriations are reduced for other providers. If the index

• Page 28, Line 4shows that general fund appropriations are reduced for other providers,

• Page 28, Line 5the general fund appropriations for hospital reimbursements shall not be

• Page 28, Line 6reduced by a greater percentage than the reductions of appropriations for the other providers as shown by the index.

• Page 28, Line 7(IV)  Except as otherwise provided in subsection (5.5)(b)(V)

• Page 28, Line 8of this section, the nursing facility provider fee is to supplement,

• Page 28, Line 9not supplant, general fund appropriations to support nursing facility provider reimbursements.

• Page 28, Line 10(V)  Except as otherwise provided in subsection (5.7)(b)(II)

• Page 28, Line 11of this section, the intermediate care facility fee is to

• Page 28, Line 12supplement, not supplant, general fund appropriations to support intermediate care facility reimbursements.

• Page 28, Line 13(b)  If the revenue from the healthcare affordability and

• Page 28, Line 14sustainability hospital provider fee is insufficient to fully fund all of the purposes described in subsection (5)(b) of this section:

• Page 28, Line 15(II)  The hospital provider reimbursement and quality incentive

• Page 28, Line 16payment increases described in subsections (5)(b)(I) to (5)(b)(III) of this

• Page 28, Line 17section and the costs described in subsection (5)(b)(VI) of this section

• Page 28, Line 18shall be fully funded using revenue from the healthcare affordability and

• Page 28, Line 19sustainability hospital provider fee and federal matching funds before any eligibility expansion is funded; and

• Page 28, Line 20(III) (A)  If the state board promulgates rules that expand eligibility

• Page 28, Line 21for medical assistance to be paid for pursuant to subsection (5)(b)(IV) of

• Page 28, Line 22this section, and the state department thereafter notifies the enterprise

• Page 29, Line 1board that the revenue available from the healthcare affordability and

• Page 29, Line 2sustainability hospital provider fee and the federal matching funds will

• Page 29, Line 3not be sufficient to pay for all or part of the expanded eligibility, the

• Page 29, Line 4enterprise board shall recommend to the state board reductions in medical

• Page 29, Line 5benefits or eligibility so that the revenue will be sufficient to pay for all

• Page 29, Line 6of the reduced benefits or eligibility. After receiving the

• Page 29, Line 7recommendations of the enterprise board, the state board shall adopt rules

• Page 29, Line 8providing for reduced benefits or reduced eligibility for which the

• Page 29, Line 9revenue will be sufficient and shall forward any adopted rules to the joint

• Page 29, Line 10budget committee. Notwithstanding the provisions of section 24-4-103

• Page 29, Line 11(8) and (12), following the adoption of rules pursuant to this subsection

• Page 29, Line 12(6)(b)(III)(A), the state board shall not submit the rules to the attorney

• Page 29, Line 13general and shall not file the rules with the secretary of state until the joint

• Page 29, Line 14budget committee approves the rules pursuant to subsection (6)(b)(III)(B) of this section.

• Page 29, Line 15(B)  The joint budget committee shall promptly consider any rules

• Page 29, Line 16adopted by the state board pursuant to subsection (6)(b)(III)(A) of this

• Page 29, Line 17section. The joint budget committee shall promptly notify the state

• Page 29, Line 18department, the state board, and the enterprise board of any action on the

• Page 29, Line 19rules. If the joint budget committee does not approve the rules, the joint

• Page 29, Line 20budget committee shall recommend a reduction in benefits or eligibility

• Page 29, Line 21so that the revenue from the healthcare affordability and sustainability

• Page 29, Line 22hospital provider fee and the matching federal funds will be sufficient

• Page 29, Line 23to pay for the reduced benefits or eligibility. After approving the rules

• Page 29, Line 24pursuant to this subsection (6)(b)(III)(B), the joint budget committee shall

• Page 29, Line 25request that the committee on legal services, created pursuant to section

• Page 29, Line 262-3-501, extend the rules as provided for in section 24-4-103 (8) unless

• Page 30, Line 1the committee on legal services finds after review that the rules do not conform with section 24-4-103 (8)(a).

• Page 30, Line 2(b.5)  If the revenue from the nursing facility provider fee

• Page 30, Line 3is insufficient to fully fund all of the purposes described in subsection (5.5)(b) of this section:

• Page 30, Line 4(I)  The general assembly is not obligated to appropriate general fund revenues to fund such purposes; and

• Page 30, Line 5(II)  Subject to the priority of the uses for the nursing

• Page 30, Line 6facility provider fee as provided in subsection (5.5)(b) of this

• Page 30, Line 7section, the enterprise, in consultation with the state

• Page 30, Line 8department, may suspend or reduce any supplemental medicaid payment.

• Page 30, Line 9(c)  Notwithstanding any other provision of this section, if, after

• Page 30, Line 10receipt of authorization to receive federal matching funds for money in

• Page 30, Line 11the hospital provider fee cash fund, the authorization is withdrawn or

• Page 30, Line 12changed so that federal matching funds are no longer available, the

• Page 30, Line 13enterprise shall cease collecting the healthcare affordability and

• Page 30, Line 14sustainability hospital provider fee and shall repay to the hospitals any

• Page 30, Line 15money received by the hospital provider fee cash fund that is not subject to federal matching funds.

• Page 30, Line 16(c.5)  Notwithstanding any other provision of this section,

• Page 30, Line 17if, after receipt of authorization to receive federal matching

• Page 30, Line 18funds for money in the nursing facility provider fee cash fund,

• Page 30, Line 19the authorization is withdrawn or changed so that federal

• Page 30, Line 20matching funds are no longer available, the enterprise shall

• Page 30, Line 21cease collecting the nursing facility provider fee and shall

• Page 30, Line 22repay to the nursing facility providers any money received in

• Page 31, Line 1the nursing facility provider fee cash fund that is not subject to federal matching funds.

• Page 31, Line 2(c.7)  Notwithstanding any other provision of this section,

• Page 31, Line 3if, after receipt of authorization to receive federal matching

• Page 31, Line 4funds for money in the intermediate care facility fee cash fund,

• Page 31, Line 5the authorization is withdrawn or changed so that federal

• Page 31, Line 6matching funds are no longer available, the enterprise shall

• Page 31, Line 7cease collecting the intermediate care facility fee and shall

• Page 31, Line 8repay to the intermediate care facilities any money received in

• Page 31, Line 9the intermediate care facility fee cash fund that is not subject to federal matching funds.

• Page 31, Line 10(7) Colorado healthcare affordability and sustainability

• Page 31, Line 11enterprise board. (b)  Members of the enterprise board serve without

• Page 31, Line 12compensation but must be reimbursed from money in the hospital

• Page 31, Line 13provider fee cash fund for actual and necessary expenses incurred in the performance of their duties pursuant to this section.

• Page 31, Line 14(d)  The enterprise board has, at a minimum, the following duties:

• Page 31, Line 15(I)  To determine the timing and method by which the enterprise

• Page 31, Line 16assesses the healthcare affordability and sustainability hospital provider fee and the amount of the fee;

• Page 31, Line 17(II)  If requested by the health and human services committee of

• Page 31, Line 18the senate or the public health care and human services committee of the

• Page 31, Line 19house of representatives, or any successor committees, to consult with the

• Page 31, Line 20committees on any legislation that may impact the healthcare affordability

• Page 31, Line 21and sustainability fee fees, payments, or hospital reimbursements established pursuant to this section;

• Page 31, Line 22(III)  To determine changes in the healthcare affordability and

• Page 32, Line 1sustainability hospital provider fee that increase the number of

• Page 32, Line 2hospitals benefitting from the uses of the healthcare affordability and

• Page 32, Line 3sustainability fee described in subsections (5)(b)(I) to (5)(b)(IV) of this

• Page 32, Line 4section or that minimize the number of hospitals that suffer losses as a

• Page 32, Line 5result of paying the healthcare affordability and sustainability hospital provider fee;

• Page 32, Line 6(IX)  To monitor the impact of the healthcare affordability and

• Page 32, Line 7sustainability hospital provider fee, the nursing facility provider

• Page 32, Line 8fee, and the intermediate care facility fee on the broader health-care marketplace;

• Page 32, Line 9(X)  To establish requirements for the reports that hospitals must

• Page 32, Line 10submit to the enterprise to allow the enterprise to calculate the amount of

• Page 32, Line 11the healthcare affordability and sustainability hospital provider fee; and

• Page 32, Line 12(e)  On or before January 15, 2018, and on or before January 15

• Page 32, Line 13each year thereafter, the enterprise board shall submit a written report to

• Page 32, Line 14the health and human services committee of the senate and the public

• Page 32, Line 15health care and human services committee of the house of representatives,

• Page 32, Line 16or any successor committees, the joint budget committee of the general

• Page 32, Line 17assembly, the governor, and the state board. The report shall include, but need not be limited to:

• Page 32, Line 18(II)  A description of the formula for how the healthcare

• Page 32, Line 19affordability and sustainability hospital provider fee is calculated and

• Page 32, Line 20the process by which the healthcare affordability and sustainability fee is assessed and collected;

• Page 32, Line 21(II.5)  A description of the formula for how the nursing

• Page 32, Line 22facility provider fee is calculated and the process by which the fee is assessed and collected;

• Page 33, Line 1(II.7)  A description of the formula for how the

• Page 33, Line 2intermediate care facility fee is calculated and the process by which the fee is assessed and collected;

• Page 33, Line 3(III)  An itemization of the total amount of the healthcare

• Page 33, Line 4affordability and sustainability hospital provider fee paid by each

• Page 33, Line 5hospital and any projected revenue that each hospital is expected to receive due to:

• Page 33, Line 6(III.5)  An itemization of the total amount of the nursing

• Page 33, Line 7facility provider fee paid by each nursing facility provider and

• Page 33, Line 8any projected revenue that each nursing facility provider is

• Page 33, Line 9expected to receive due to increased reimbursements and

• Page 33, Line 10supplemental payments made pursuant to subsection (5.5)(b) of this section;

• Page 33, Line 11(III.7)  An itemization of the total amount of the

• Page 33, Line 12intermediate care facility fee paid by each intermediate care

• Page 33, Line 13facility for individuals with intellectual disabilities and any

• Page 33, Line 14projected revenue that each intermediate care facility is

• Page 33, Line 15expected to receive due to increased reimbursements made pursuant to subsection (5.7)(b) of this section;

• Page 33, Line 16(IV)  An itemization of the costs incurred by the enterprise in

• Page 33, Line 17implementing and administering the healthcare affordability and

• Page 33, Line 18sustainability hospital provider fee, the nursing facility provider fee, and the intermediate care facility fee;

• Page 33, Line 19(g) (I)  The facility provider fee enterprise support board

• Page 33, Line 20is created within the enterprise for the purpose of supporting the

• Page 33, Line 21enterprise board with the implementation of the nursing facility

• Page 34, Line 1provider fee and the intermediate care facility fee. The facility

• Page 34, Line 2provider fee enterprise support board consists of eight members

• Page 34, Line 3appointed by the governor, with the advice and consent of the senate, as follows:

• Page 34, Line 4(A)  Two members who are representatives of nursing facility associations;

• Page 34, Line 5(B)  Two members who are representatives of nursing

• Page 34, Line 6facilities, with one member representing a rural nursing facility;

• Page 34, Line 7(C)  One member who is a resident of a long-term care

• Page 34, Line 8facility or a consumer of long-term care services, or a family member or guardian representing such resident or consumer;

• Page 34, Line 9(D)  One employee of the state department;

• Page 34, Line 10(E)  One employee of the department of human services created in section 24-1-120; and

• Page 34, Line 11(F)  One employee of the department of public health and environment created in section 25-1-102.

• Page 34, Line 12(II) (A)  Members of the facility provider fee enterprise

• Page 34, Line 13support board serve at the pleasure of the governor. All terms

• Page 34, Line 14are for four years. A member who is appointed to fill a vacancy

• Page 34, Line 15shall serve the remainder of the unexpired term of the former member.

• Page 34, Line 16(B)  The governor shall make the initial appointments to

• Page 34, Line 17the facility provider fee enterprise support board as soon as practical following May 1, 2025.

• Page 34, Line 18(III)  The facility provider fee enterprise support board

• Page 34, Line 19shall elect a chair and a vice-chair from among its members.

• Page 35, Line 1(IV)  The facility provider fee enterprise support board

• Page 35, Line 2shall fulfill, at a minimum, the following duties on behalf of the enterprise:

• Page 35, Line 3(A)  To determine the timing and method by which the

• Page 35, Line 4enterprise assesses the nursing facility provider fee and the intermediate care facility fee and the amounts of the fees;

• Page 35, Line 5(B)  To determine changes in the nursing facility provider

• Page 35, Line 6fee that increase the number of nursing facility providers

• Page 35, Line 7benefitting from the uses of the fee described in subsection

• Page 35, Line 8(5.5)(b) of this section or that minimize the number of nursing

• Page 35, Line 9facility providers that suffer losses as a result of paying the nursing facility provider fee;

• Page 35, Line 10(C)  To determine changes in the intermediate care facility

• Page 35, Line 11fee that increase the number of intermediate care facilities for

• Page 35, Line 12individuals with intellectual disabilities that benefit from the

• Page 35, Line 13uses of the fee described in subsection (5.7)(b) of this section or

• Page 35, Line 14that minimize the number of intermediate care facilities for

• Page 35, Line 15individuals with intellectual disabilities that suffer losses as a result of paying the nursing facility provider fee;

• Page 35, Line 16(D)  To consult with the state board on the rules

• Page 35, Line 17regarding payments to nursing facility providers that it adopts pursuant to section 25.5-6-202 (10) and (14)(a);

• Page 35, Line 18(E)  To consult with the state board and the state

• Page 35, Line 19department on the rules, price schedules, and allowances

• Page 35, Line 20regarding reimbursement and payments to intermediate care facilities that they adopt pursuant to section 25.5-6-204;

• Page 35, Line 21(F)  To establish requirements for the reports that

• Page 36, Line 1nursing facility providers must submit to the enterprise to

• Page 36, Line 2allow the enterprise to calculate the amount of the nursing facility provider fee; and

• Page 36, Line 3(G)  To establish requirements for the reports that

• Page 36, Line 4intermediate care facilities must submit to the enterprise to

• Page 36, Line 5allow the enterprise to calculate the amount of the intermediate care facility fee.

• Page 36, Line 6(V)  Members of the facility provider fee enterprise

• Page 36, Line 7support board serve without compensation but must be

• Page 36, Line 8reimbursed from money in the nursing facility provider fee cash

• Page 36, Line 9fund or the intermediate care facility fee cash fund for actual

• Page 36, Line 10and necessary expenses incurred in the performance of their duties pursuant to this section.

• Page 36, Line 11(9)  Definitions.As used in this section, unless the context otherwise requires:

• Page 36, Line 12(a)  "Case-mix" has the same meaning as set forth in section 25.5-6-201 (8).

• Page 36, Line 13(b)  "Case-mix reimbursement" has the same meaning as set forth in section 25.5-6-201 (12).

• Page 36, Line 14(c)  "Colorado healthcare affordability and

• Page 36, Line 15sustainability enterprise" or "enterprise" means the enterprise created in subsection (3) of this section.

• Page 36, Line 16(d)  "Facility provider fee enterprise support board" means

• Page 36, Line 17the facility provider fee enterprise support board created in subsection (7)(g) of this section.

• Page 36, Line 18(e)  "Healthcare affordability and sustainability hospital

• Page 36, Line 19provider fee" or "hospital provider fee" means the healthcare

• Page 37, Line 1affordability and sustainability hospital provider fee charged and collected as authorized by subsection (4) of this section.

• Page 37, Line 2(f)  "Healthcare affordability and sustainability hospital

• Page 37, Line 3provider fee cash fund" or "hospital provider fee cash fund"

• Page 37, Line 4means the healthcare affordability and sustainability hospital provider fee cash fund created in subsection (5) of this section.

• Page 37, Line 5(g)  "Healthcare affordability and sustainability

• Page 37, Line 6intermediate care facility fee" or "intermediate care facility

• Page 37, Line 7fee" means the healthcare affordability and sustainability

• Page 37, Line 8intermediate care facility fee for intermediate care facilities

• Page 37, Line 9for individuals with intellectual disabilities charged and collected as authorized by subsection (4.7) of this section.

• Page 37, Line 10(h)  "Healthcare affordability and sustainability

• Page 37, Line 11intermediate care facility fee cash fund" or "intermediate care

• Page 37, Line 12facility fee cash fund" means the healthcare affordability and

• Page 37, Line 13sustainability intermediate care facility fee cash fund created in subsection (5.7) of this section.

• Page 37, Line 14(i)  "Healthcare affordability and sustainability nursing

• Page 37, Line 15facility provider fee" or "nursing facility provider fee" means

• Page 37, Line 16the healthcare affordability and sustainability nursing facility

• Page 37, Line 17provider fee charged and collected as authorized by subsection (4.5) of this section.

• Page 37, Line 18(j)  "Healthcare affordability and sustainability nursing

• Page 37, Line 19facility provider fee cash fund" or "nursing facility provider fee

• Page 37, Line 20cash fund" means the healthcare affordability and

• Page 37, Line 21sustainability nursing facility provider fee cash fund created in

• Page 37, Line 22subsection (5.5) of this section.

• (k)  "Hospital" means a licensed or certified hospital.

• Page 38, Line 1(l)  "Nursing facility provider" has the same meaning as set forth in section 25.5-6-201 (25).

• Page 38, Line 2(m)  "State medical assistance program" means the

• Page 38, Line 3program described in this article 4 and articles 5 and 6 of this title 25.5.

• Page 38, Line 4(n)  "Statewide average per diem rate" has the same meaning as set forth in section 25.5-6-201 (35).

• Page 38, Line 5(o)  "Supplemental medicaid payment" has the same meaning as set forth in section 25.5-6-201 (36).

• Page 38, Line 6SECTION 2.  In Colorado Revised Statutes, 25.5-4-402.4, amend

• Page 38, Line 7(2) introductory portion and (2)(d) introductory portion; and amend as

• Page 38, Line 8they will become effective July 1, 2025, (2)(d)(I), (4)(a) introductory portion, and (4)(g)(I) as follows:

• Page 38, Line 925.5-4-402.4.  Healthcare affordability and sustainability

• Page 38, Line 10hospital provider fee - healthcare affordability and sustainability

• Page 38, Line 11nursing facility provider fee - healthcare affordability and

• Page 38, Line 12sustainability intermediate care facility fee - Colorado healthcare

• Page 38, Line 13affordability and sustainability enterprise - federal waiver - funds

• Page 38, Line 14created - reports - rules - legislative declaration - repeal.

• Page 38, Line 15(2)  Legislative declaration. The general assembly hereby finds and declares that:

• Page 38, Line 16(d)  The Colorado healthcare affordability and sustainability

• Page 38, Line 17enterprise provides business services to hospitals when, in exchange for

• Page 38, Line 18payment of healthcare affordability and sustainability hospital provider fees by hospitals, it:

• Page 38, Line 19(I)  Obtains federal matching money and returns both the

• Page 39, Line 1healthcare affordability and sustainability hospital provider fee and the

• Page 39, Line 2federal matching money to hospitals to increase reimbursement rates to

• Page 39, Line 3hospitals for providing medical care under the state medical assistance

• Page 39, Line 4program, including disproportionate share hospital payments pursuant to

• Page 39, Line 542 U.S.C. sec. 1396r-4, and to increase the number of individuals covered by public medical assistance; and

• Page 39, Line 6(4) Healthcare affordability and sustainability fee. (a)   For the

• Page 39, Line 7fiscal year commencing July 1, 2017, and for each fiscal year thereafter,

• Page 39, Line 8the enterprise is authorized to charge and collect a healthcare affordability

• Page 39, Line 9and sustainability hospital provider fee, as described in 42 CFR 433.68

• Page 39, Line 10(b), on outpatient and inpatient services provided by all licensed or

• Page 39, Line 11certified hospitals referred to in this section as "hospitals", for the purpose

• Page 39, Line 12of obtaining federal financial participation under the state medical

• Page 39, Line 13assistance program as described in this article 4 and articles 5 and 6 of

• Page 39, Line 14this title 25.5, referred to in this section as the "state medical assistance

• Page 39, Line 15program", including disproportionate share hospital payments pursuant

• Page 39, Line 16to 42 U.S.C. sec. 1396r-4. If the amount of healthcare affordability and

• Page 39, Line 17sustainability hospital provider fee revenue collected exceeds the

• Page 39, Line 18federal net patient revenue-based limit on the amount of such fee revenue

• Page 39, Line 19that may be collected, requiring repayment to the federal government of

• Page 39, Line 20excess federal matching money received, hospitals that received such

• Page 39, Line 21excess federal matching money are responsible for repaying the excess

• Page 39, Line 22federal money and any associated federal penalties to the federal

• Page 39, Line 23government. The enterprise shall use the healthcare affordability and sustainability hospital provider fee revenue to:

• Page 39, Line 24(g) (I)  The state board shall promulgate any rules pursuant to the

• Page 39, Line 25"State Administrative Procedure Act", article 4 of title 24, necessary for

• Page 40, Line 1the administration and implementation of this section. Prior to submitting

• Page 40, Line 2any proposed rules concerning the administration or implementation of

• Page 40, Line 3the healthcare affordability and sustainability hospital provider fee to

• Page 40, Line 4the state board, the enterprise shall consult with the state board on the proposed rules as specified in subsection (7)(d) of this section.

• Page 40, Line 5SECTION 3.  In Colorado Revised Statutes, 25.5-5-103, amend (1)(b) as follows:

• Page 40, Line 625.5-5-103.  Mandated programs with special state provisions

• Page 40, Line 7- rules. (1)  This section specifies programs developed by Colorado to meet federal mandates. These programs include but are not limited to:

• Page 40, Line 8(b)  Special provisions relating to nursing facilities, as specified in

• Page 40, Line 9sections 25.5-6-201 to 25.5-6-203, 25.5-6-205, and 25.5-6-206 sections

• Page 40, Line 1025.5-4-402.4 (4.5) and (5.5), 25.5-6-201, 25.5-6-202, 25.5-6-205, and 25.5-6-206;

• Page 40, Line 11SECTION 4.  In Colorado Revised Statutes, 25.5-6-202, amend

• Page 40, Line 12(9)(b)(I) introductory portion, (9)(b)(II), and (9)(b)(VI); and repeal (5), (6), (7), (9)(b.3), and (9)(d) as follows:

• Page 40, Line 1325.5-6-202.  Providers - nursing facility provider

• Page 40, Line 14reimbursement - exemption - rules - repeal. (5)  Subject to available

• Page 40, Line 15appropriations and the priority of the uses of the provider fees as

• Page 40, Line 16established in section 25.5-6-203 (2)(b), in addition to the reimbursement

• Page 40, Line 17rate components paid pursuant to subsections (1) to (4) of this section, the

• Page 40, Line 18state department shall make a supplemental medicaid payment based

• Page 40, Line 19upon performance to those nursing facility providers that provide services

• Page 40, Line 20that result in better care and higher quality of life for their residents. The

• Page 40, Line 21state department shall determine the payment amount based upon

• Page 40, Line 22performance measures established in rules adopted by the state board in

• Page 41, Line 1the domains of quality of life, quality of care, and facility management.

• Page 41, Line 2Beginning July 1, 2024, the payment must not be less than twelve percent

• Page 41, Line 3of total provider fee payments and must be adjusted for fiscal years

• Page 41, Line 42024-25 and 2025-26. No later than July 1, 2026, the payment must not

• Page 41, Line 5be less than fifteen percent of total provider fee payments and must be

• Page 41, Line 6annually adjusted thereafter. During each state fiscal year, the state

• Page 41, Line 7department may discontinue the supplemental medicaid payment

• Page 41, Line 8established pursuant to this subsection (5) to any nursing facility provider

• Page 41, Line 9that fails to comply with the established performance measures during the

• Page 41, Line 10state fiscal year, and the state department may initiate the supplemental

• Page 41, Line 11medicaid payment established pursuant to this subsection (5) to any

• Page 41, Line 12provider that comes into compliance with the established performance measures during the state fiscal year.

• Page 41, Line 13(6)  Subject to available appropriations and the priority of the uses

• Page 41, Line 14of the provider fees as established in section 25.5-6-203 (2)(b), in

• Page 41, Line 15addition to the reimbursement rate components paid pursuant to

• Page 41, Line 16subsections (1) to (5) of this section, the state department shall make a

• Page 41, Line 17supplemental medicaid payment to nursing facility providers that serve residents:

• Page 41, Line 18(a)  Who have severe mental health conditions that are classified

• Page 41, Line 19at a level II by the medicaid program's preadmission screening and

• Page 41, Line 20resident review assessment tool. The state department shall compute this

• Page 41, Line 21payment annually as of July 1, 2009, and each July 1 thereafter, and it

• Page 41, Line 22must not be less than two percent of the statewide average per diem rate

• Page 41, Line 23for the combined rate components determined pursuant to subsections (1)

• Page 41, Line 24to (4) of this section. Beginning July 1, 2023, the state department shall

• Page 41, Line 25annually adjust the rate to ensure access to care for residents who have severe mental health conditions.

• Page 42, Line 1(b)  With severe dementia diseases and related disabilities or

• Page 42, Line 2acquired brain injury. The state department shall calculate the payment

• Page 42, Line 3based upon the resident's cognitive assessment established in rules

• Page 42, Line 4adopted by the state board. The state department shall compute this

• Page 42, Line 5payment annually as of July 1, 2009, and each July 1 thereafter, and it

• Page 42, Line 6must not be less than one percent of the statewide average per diem rate

• Page 42, Line 7for the combined rate components determined pursuant to subsections (1)

• Page 42, Line 8to (4) of this section. Beginning July 1, 2023, the state department shall

• Page 42, Line 9annually adjust the rate to ensure access to care for residents with severe dementia diseases and related disabilities or acquired brain injury.

• Page 42, Line 10(7)  Subject to available moneys and the priority of the uses of the

• Page 42, Line 11provider fees as established in section 25.5-6-203 (2)(b), in addition to the

• Page 42, Line 12reimbursement rate components paid pursuant to subsections (1) to (6) of

• Page 42, Line 13this section, the state department shall pay a nursing facility provider a

• Page 42, Line 14supplemental medicaid payment for care and services rendered to

• Page 42, Line 15medicaid residents to offset payment of the provider fee assessed under

• Page 42, Line 16the provisions of section 25.5-6-203. The state department shall compute this payment annually, as of July 1, 2009, and each July 1 thereafter.

• Page 42, Line 17(9) (b) (I)  Except for changes in the number of patient days, the

• Page 42, Line 18state department shall establish the general fund share of the aggregate

• Page 42, Line 19statewide average of the per diem rate net of patient payment pursuant to

• Page 42, Line 20subsections (1) to (4) of this section. The state's share of the

• Page 42, Line 21reimbursement rate components pursuant to subsections (1) to (4) of this

• Page 42, Line 22section may be funded through the provider fee assessed pursuant to

• Page 42, Line 23section 25.5-6-203 section 25.5-4-402.4 (4.5) and any associated federal

• Page 42, Line 24funds. Any provider fee used as the state's share and all federal funds

• Page 43, Line 1must be excluded from the calculation of the general fund share. For the

• Page 43, Line 2fiscal year commencing July 1, 2009, and for each fiscal year thereafter,

• Page 43, Line 3the state department shall calculate the general fund share of the

• Page 43, Line 4aggregate statewide average per diem rate net of patient payment pursuant

• Page 43, Line 5to subsections (1) to (4) of this section using the rates that were effective on July 1 of that fiscal year; except that:

• Page 43, Line 6(II)  If the aggregate statewide average per diem rate net of patient

• Page 43, Line 7payment pursuant to subsections (1) to (4) of this section exceeds the

• Page 43, Line 8general fund share, the amount of the average statewide per diem rate that

• Page 43, Line 9exceeds the general fund share shall must be paid as a supplemental

• Page 43, Line 10medicaid payment using the provider fee established under section

• Page 43, Line 1125.5-6-203 section 25.5-4-402.4 (4.5). Subject to the priority of the uses

• Page 43, Line 12of the provider fee established under section 25.5-6-203 (2)(b) section

• Page 43, Line 1325.5-4-402.4 (5.5)(b), if the provider fee is insufficient to fully fund the

• Page 43, Line 14supplemental medicaid payment, the supplemental medicaid payment shall must be reduced to all providers proportionately.

• Page 43, Line 15(VI)  Notwithstanding any other provision of law, for the fiscal

• Page 43, Line 16year commencing July 1, 2013, and each fiscal year thereafter, the general

• Page 43, Line 17fund portion of the per diem rate pursuant to subsections (1) to (4) of this

• Page 43, Line 18section shall be reduced by one and one-half percent. The state

• Page 43, Line 19department may, but is not required to, increase the supplemental

• Page 43, Line 20medicaid payment pursuant to subparagraph (II) of this paragraph (b)

• Page 43, Line 21subsection (9)(b)(II) of this section due to this reduction. except that

• Page 43, Line 22the provider fee shall not exceed the amount specified in section 25.5-6-203 (1)(a)(II).

• Page 43, Line 23(b.3) (I)  For the fiscal year commencing July 1, 2009, and for each

• Page 43, Line 24fiscal year thereafter, if the provider fee established under section

• Page 44, Line 125.5-6-203 is insufficient to fully fund the supplemental medicaid

• Page 44, Line 2payments established under subsections (5) to (7) of this section, subject

• Page 44, Line 3to the priority of the uses of the provider fee established pursuant to

• Page 44, Line 4section 25.5-6-203 (2)(b), the state department may suspend or reduce the

• Page 44, Line 5supplemental medicaid payment subject to the uses of the provider fee established under section 25.5-6-203.

• Page 44, Line 6(II)  If it is determined by the state department that the case-mix

• Page 44, Line 7reimbursement includes a factor for nursing facility providers that serve

• Page 44, Line 8residents with severe dementia diseases and related disabilities or

• Page 44, Line 9acquired brain injury, the state department may eliminate the

• Page 44, Line 10supplemental medicaid payment to those providers that serve residents

• Page 44, Line 11with severe dementia diseases and related disabilities or acquired brain injury.

• Page 44, Line 12(d)  The reimbursement rate components pursuant to subsections

• Page 44, Line 13(5) to (7) of this section shall be funded entirely through the provider fee

• Page 44, Line 14assessed pursuant to the provisions of section 25.5-6-203 and any

• Page 44, Line 15associated federal funds. No general fund moneys shall be used to pay for

• Page 44, Line 16the reimbursement rate components established pursuant to subsections (5) to (7) of this section.

• Page 44, Line 17SECTION 5.  In Colorado Revised Statutes, 25.5-6-203, repeal (1); and add (2)(a.5) and (3) as follows:

• Page 44, Line 1825.5-6-203.  Nursing facilities - provider fees - federal waiver

• Page 44, Line 19- fund created - rules - repeal. (1) (a) (I)  Beginning with the fiscal year

• Page 44, Line 20commencing July 1, 2008, and each fiscal year thereafter, the state

• Page 44, Line 21department shall charge and collect provider fees on health-care items or

• Page 44, Line 22services provided by nursing facility providers for the purpose of

• Page 44, Line 23obtaining federal financial participation under the state's medical

• Page 45, Line 1assistance program as described in articles 4 to 6 of this title. As specified

• Page 45, Line 2by the priority of the uses of the provider fee in paragraph (b) of

• Page 45, Line 3subsection (2) of this section, the provider fees shall be used to sustain or

• Page 45, Line 4increase reimbursement for providing medical care under the state's medical assistance program for nursing facility providers.

• Page 45, Line 5(II)  For the fiscal years commencing July 1, 2009, and July 1,

• Page 45, Line 62010, the provider fee shall not exceed seven dollars and fifty cents per

• Page 45, Line 7nonmedicare-resident day. For the fiscal year commencing July 1, 2011,

• Page 45, Line 8and each fiscal year thereafter, the provider fee shall not exceed twelve

• Page 45, Line 9dollars per nonmedicare-resident day plus inflation based on the national

• Page 45, Line 10skilled nursing facility market basket index as determined by the secretary

• Page 45, Line 11of the department of health and human services pursuant to 42 U.S.C. sec. 1395yy (e)(5) or any successor index.

• Page 45, Line 12(III)  In calculating the amount of the provider fee portion of the

• Page 45, Line 13supplemental medicaid payments established under section 25.5-6-202

• Page 45, Line 14(5), the state department may include an additional amount of up to five

• Page 45, Line 15percent of the provider fee portion of said supplemental medicaid

• Page 45, Line 16payments to initiate the payment to any provider who complies with the established performance measures during the state fiscal year.

• Page 45, Line 17(b)  The provider fees shall be charged on a nonmedicare-resident

• Page 45, Line 18day basis and shall be based upon the aggregate gross or net revenue, as

• Page 45, Line 19prescribed by the state department, of all nursing facility providers subject

• Page 45, Line 20to the provider fee. The state department may exempt revenue categories

• Page 45, Line 21from the gross or net revenue calculation and the collection of the provider fee from nursing facility providers, as authorized by federal law.

• Page 45, Line 22(c) (I)  In accordance with the redistributive method set forth in 42

• Page 45, Line 23CFR 433.68 (e)(1) and (e)(2), the state department shall seek a waiver

• Page 46, Line 1from the broad-based provider fees requirement or the uniform provider

• Page 46, Line 2fees requirement, or both, to exclude nursing facility providers from the

• Page 46, Line 3provider fee. The state department shall exempt the following nursing

• Page 46, Line 4facility providers to obtain federal approval and minimize the financial impact on nursing facility providers:

• Page 46, Line 5(A)  A facility operated as a continuing care retirement community

• Page 46, Line 6that provides a continuum of services by one operational entity providing

• Page 46, Line 7independent living services, assisted living services, and skilled nursing

• Page 46, Line 8care on a single, contiguous campus. Assisted living services include an

• Page 46, Line 9assisted living residence as defined in section 25-27-102 or that provides

• Page 46, Line 10assisted living services on-site, twenty-four hours per day, seven days per week.

• Page 46, Line 11(B)  A skilled nursing facility owned and operated by the state;

• Page 46, Line 12(C)  A nursing facility that is a distinct part of a facility that is licensed as a general acute care hospital; and

• Page 46, Line 13(D)  A facility that has forty-five or fewer licensed beds.

• Page 46, Line 14(II)  No later than July 1, 2026, the state department shall

• Page 46, Line 15promulgate rules maintaining the exemptions identified in this subsection

• Page 46, Line 16(1)(c) in order to minimize the financial impact on nursing facility providers.

• Page 46, Line 17(III)  This subsection (1)(c) is repealed, effective July 1, 2028.

• Page 46, Line 18(d)  The state department may lower the amount of the provider fee

• Page 46, Line 19charged to certain nursing facility providers to meet the requirements of 42 CFR 433.68 (e) and to obtain federal approval.

• Page 46, Line 20(e)  The imposition and collection of a provider fee shall be

• Page 46, Line 21prohibited without the federal government's approval of a state medicaid

• Page 46, Line 22plan amendment authorizing federal financial participation for the

• Page 47, Line 1provider fees. The state department may alter the method prescribed in

• Page 47, Line 2this section to the extent necessary to meet the federal requirements and to obtain federal approval.

• Page 47, Line 3(f)  If the provider fee required by this subsection (1) is not

• Page 47, Line 4approved by the federal government, notwithstanding any other provision

• Page 47, Line 5of this section, the state department shall not implement the assessment or collection of the provider fee from nursing facility providers.

• Page 47, Line 6(g)  The state department shall establish a schedule to assess and

• Page 47, Line 7collect the provider fee on a monthly basis. The state board shall establish

• Page 47, Line 8rules so that provider fee payments from a nursing facility provider and

• Page 47, Line 9the state department's supplemental medicaid payments to the nursing

• Page 47, Line 10facility are due as nearly simultaneously as feasible; except that the state

• Page 47, Line 11department's supplemental medicaid payments to the nursing facility shall

• Page 47, Line 12be due no more than fifteen days after the provider fee payment is

• Page 47, Line 13received from the nursing facility. The state department shall require each

• Page 47, Line 14nursing facility provider to report annually its total number of days of care provided to nonmedicare residents.

• Page 47, Line 15(h)  The state department shall not assess or collect the provider

• Page 47, Line 16fee until state medicaid plan amendments adopting the medicaid

• Page 47, Line 17reimbursement system for the state's class I nursing facility providers,

• Page 47, Line 18pursuant to section 25.5-6-202, including the waiver with respect to the

• Page 47, Line 19provider fees pursuant to this section, have been approved by the federal government.

• Page 47, Line 20(i)  The state board shall promulgate any rules pursuant to the

• Page 47, Line 21"State Administrative Procedure Act", article 4 of title 24, C.R.S., necessary for the administration and implementation of this section.

• Page 47, Line 22(j)  A nursing facility provider shall not include any amount of the provider fee as a separate line item in its billing statements.

• Page 48, Line 1(2) (a.5)  Notwithstanding any provision of this subsection

• Page 48, Line 2(2) to the contrary, on June 30, 2025, the state treasurer shall

• Page 48, Line 3transfer the balance of the fund to the healthcare

• Page 48, Line 4affordability and sustainability nursing facility provider fee cash fund created in section 25.5-4-402.4 (5.5).

• Page 48, Line 5(3)  This section is repealed, effective July 1, 2025.

• Page 48, Line 6SECTION 6.  In Colorado Revised Statutes, 25.5-6-204, amend (1)(c) as follows:

• Page 48, Line 725.5-6-204.  Providers - reimbursement - intermediate care

• Page 48, Line 8facility for individuals with intellectual disabilities - reimbursement

• Page 48, Line 9- maximum allowable - repeal. (1) (c) (I)  Beginning in fiscal year

• Page 48, Line 102013-14, and for each fiscal year thereafter, the state department is

• Page 48, Line 11authorized to charge both privately owned intermediate care facilities for

• Page 48, Line 12individuals with intellectual disabilities and state-operated intermediate

• Page 48, Line 13care facilities for individuals with intellectual disabilities a service fee for

• Page 48, Line 14the purposes of maintaining the quality and continuity of services

• Page 48, Line 15provided by intermediate care facilities for individuals with intellectual

• Page 48, Line 16disabilities. The service fee charged by the state department pursuant to

• Page 48, Line 17this paragraph (c) will be assessed pursuant to rules adopted by the state

• Page 48, Line 18board but must not exceed five percent of the total costs incurred by all

• Page 48, Line 19intermediate care facilities for the fiscal year in which the service fee is

• Page 48, Line 20charged. The state board shall adopt rules consistent with federal law in order to implement the provisions of this paragraph (c).

• Page 48, Line 21(II)  The moneys collected in each fiscal year pursuant to

• Page 48, Line 22subparagraph (I) of this paragraph (c) shall be transmitted by the state

• Page 48, Line 23department to the state treasurer, who shall credit the same to The service

• Page 49, Line 1fee fund which fund is hereby created and referred to in this paragraph (c)

• Page 49, Line 2subsection (1)(c) as the "fund". The moneys money in the fund shall be

• Page 49, Line 3subject to annual appropriation by the general assembly to the state

• Page 49, Line 4department to be used toward the state match for the federal financial

• Page 49, Line 5participation to reimburse intermediate care facilities for individuals with

• Page 49, Line 6intellectual disabilities pursuant to this section. Any unexpended and

• Page 49, Line 7unencumbered moneys money remaining in the fund at the end of any

• Page 49, Line 8fiscal year shall remain in the fund and not be credited or transferred to the general fund or any other fund.

• Page 49, Line 9(III) (A)  Notwithstanding any provision of this subsection

• Page 49, Line 10(1)(c) to the contrary, on June 30, 2025, the state treasurer shall

• Page 49, Line 11transfer the balance of the service fee fund to the healthcare

• Page 49, Line 12affordability and sustainability intermediate care facility fee cash fund created in section 25.5-4-402.4 (5.7).

• Page 49, Line 13(B)  This subsection (1)(c) is repealed, effective July 1, 2025.

• Page 49, Line 14SECTION 7.  In Colorado Revised Statutes, 25.5-6-210, amend (4)(b) as follows:

• Page 49, Line 1525.5-6-210.  Additional supplemental payments - nursing

• Page 49, Line 16facilities - funding methodology - reporting requirement - rules -

• Page 49, Line 17repeal. (4) (b)  For the purposes of federal upper payment limit

• Page 49, Line 18calculations, the state department shall pursue federal matching funds for

• Page 49, Line 19payments made pursuant to this section but only after securing federal

• Page 49, Line 20matching funds for payments outlined in sections 25.5-6-203 (2) sections 25.5-4-402.4 (5.5)(b) and 25.5-6-208.

• Page 49, Line 21SECTION 8.  In Colorado Revised Statutes, 25-3-108, amend (7) as follows:

• Page 49, Line 2225-3-108.  Receivership. (7)  The department of public health and

• Page 50, Line 1environment shall grant the receiver a license pursuant to section

• Page 50, Line 225-3-102 and shall recommend certification for medicaid participation,

• Page 50, Line 3and the department of health care policy and financing and the

• Page 50, Line 4Colorado healthcare affordability and sustainability

• Page 50, Line 5enterprise shall reimburse the receiver for the long-term health-care

• Page 50, Line 6facility's medicaid residents pursuant to section sections 25.5-6-204 C.R.S. and 25.5-4-402.4 (5.7).

• Page 50, Line 7SECTION 9.  In Colorado Revised Statutes, amend 2-3-119 as follows:

• Page 50, Line 82-3-119.  Audit of healthcare affordability and sustainability

• Page 50, Line 9hospital provider fee - cost shift. At the discretion of the legislative

• Page 50, Line 10audit committee, the state auditor shall conduct or cause to be conducted

• Page 50, Line 11a performance and fiscal audit of the healthcare affordability and

• Page 50, Line 12sustainability hospital provider fee established pursuant to section 25.5-4-402.4.

• Page 50, Line 13SECTION 10.  In Colorado Revised Statutes, 7-121-401, amend (33.5)(b)(V) as follows:

• Page 50, Line 147-121-401.  General definitions. As used in articles 121 to 137 of this title 7, unless the context otherwise requires:

• Page 50, Line 15(33.5) (b)  Notwithstanding subsection (33.5)(a) of this section, "residential nonprofit corporation" does not include:

• Page 50, Line 16(V)  A continuing care retirement community, as described in

• Page 50, Line 17section 25.5-6-203, C.R.S. section 25.5-4-402.4 (4.5)(d)(II)(A), operated by an entity that is licensed or otherwise subject to state regulation.

• Page 50, Line 18SECTION 11.  In Colorado Revised Statutes, 10-16-1205, amend (5)(a) as follows:

• Page 50, Line 1910-16-1205.  Health insurance affordability fee - special

• Page 51, Line 1assessment on hospitals - allocation of revenues. (5) (a)  The special

• Page 51, Line 2assessments on hospitals under subsection (1)(a)(II) of this section must

• Page 51, Line 3comply with and not violate 42 CFR 433.68. If the federal centers for

• Page 51, Line 4medicare and medicaid services in the United States department of health

• Page 51, Line 5and human services informs the state that the state will not be in

• Page 51, Line 6compliance with 42 CFR 433.68 as a result of the special assessment on

• Page 51, Line 7hospitals pursuant to subsection (1)(a)(II) of this section, the enterprise

• Page 51, Line 8shall reduce the amount of the special assessment as necessary to avoid

• Page 51, Line 9any reduction in the healthcare affordability and sustainability hospital provider fee collected pursuant to section 25.5-4-402.4.

• Page 51, Line 10SECTION 12.  In Colorado Revised Statutes, 25.5-4-402.8, amend (2)(g)(I) as follows:

• Page 51, Line 1125.5-4-402.8.  Hospital transparency report and requirements

• Page 51, Line 12- definitions. (2) (g) (I)  If a hospital does not provide all of the

• Page 51, Line 13information required pursuant to subsection (2)(b) of this section, the

• Page 51, Line 14state department shall inform the hospital of its noncompliance within

• Page 51, Line 15sixty days and identify the information that needs to be provided. If a

• Page 51, Line 16hospital does not comply, the state department shall issue a corrective

• Page 51, Line 17action plan with a timeline of sixty days required for compliance. If a

• Page 51, Line 18hospital continues to not comply, the state department may create a

• Page 51, Line 19mandatory pay-for-reporting compliance measure within the hospital

• Page 51, Line 20transformation program that is tied to the healthcare affordability and

• Page 51, Line 21sustainability hospital provider fee supplemental payment and is based on compliance with subsection (2)(b) of this section.

• Page 51, Line 22SECTION 13.  In Colorado Revised Statutes, 25.5-5-201, amend (1)(o)(II) and (1)(r)(II) as follows:

• Page 51, Line 2325.5-5-201.  Optional provisions - optional groups - rules.

• Page 52, Line 1(1) (o) (II)  Notwithstanding the provisions of subsection (1)(o)(I) of this

• Page 52, Line 2section, if the money in the healthcare affordability and sustainability

• Page 52, Line 3hospital provider fee cash fund established pursuant to section

• Page 52, Line 425.5-4-402.4, together with the corresponding federal matching funds, is

• Page 52, Line 5insufficient to fully fund all of the purposes described in section

• Page 52, Line 625.5-4-402.4 (5)(b), after receiving recommendations from the Colorado

• Page 52, Line 7healthcare affordability and sustainability enterprise established pursuant

• Page 52, Line 8to section 25.5-4-402.4 (3), for individuals with disabilities who are

• Page 52, Line 9participating in the medicaid buy-in program established in part 14 of

• Page 52, Line 10article 6 of this title 25.5, the state board by rule adopted pursuant to the

• Page 52, Line 11provisions of section 25.5-4-402.4 (6)(b)(III) may reduce the medical

• Page 52, Line 12benefits offered or the percentage of the federal poverty line to below four hundred fifty percent or may eliminate this eligibility group.

• Page 52, Line 13(r) (II)  Notwithstanding the provisions of subsection (1)(r)(I) of

• Page 52, Line 14this section, if the money in the healthcare affordability and sustainability

• Page 52, Line 15hospital provider fee cash fund established pursuant to section

• Page 52, Line 1625.5-4-402.4, together with the corresponding federal matching funds, is

• Page 52, Line 17insufficient to fully fund all of the purposes described in section

• Page 52, Line 1825.5-4-402.4 (5)(b), after receiving recommendations from the Colorado

• Page 52, Line 19healthcare affordability and sustainability enterprise established pursuant

• Page 52, Line 20to section 25.5-4-402.4 (3), for persons eligible for a medicaid buy-in

• Page 52, Line 21program established pursuant to section 25.5-5-206, the state board by

• Page 52, Line 22rule adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III)

• Page 52, Line 23may reduce the medical benefits offered, or the percentage of the federal poverty line, or may eliminate this eligibility group.

• Page 52, Line 24SECTION 14.  In Colorado Revised Statutes, 25.5-5-204.5,

• Page 52, Line 25amend (2) as follows:

• Page 53, Line 125.5-5-204.5.  Continuous eligibility - children.

• Page 53, Line 2(2)  Notwithstanding the provisions of subsection (1) of this section, if the

• Page 53, Line 3money in the healthcare affordability and sustainability hospital

• Page 53, Line 4provider fee cash fund established pursuant to section 25.5-4-402.4,

• Page 53, Line 5together with the corresponding federal matching funds, is insufficient to

• Page 53, Line 6fully fund all of the purposes described in section 25.5-4-402.4 (5)(b),

• Page 53, Line 7after receiving recommendations from the Colorado healthcare

• Page 53, Line 8affordability and sustainability enterprise established pursuant to section

• Page 53, Line 925.5-4-402.4 (3), the state board by rule adopted pursuant to the

• Page 53, Line 10provisions of section 25.5-4-402.4 (6)(b)(III) may eliminate the continuous enrollment requirement pursuant to this section.

• Page 53, Line 11SECTION 15.  In Colorado Revised Statutes, 25.5-6-1403, amend (5)(b) as follows:

• Page 53, Line 1225.5-6-1403.  Waivers and amendments. (5) (b)  The state

• Page 53, Line 13department shall not prepare and submit the amendments to the state

• Page 53, Line 14medical assistance plan pursuant to this subsection (5) if there are

• Page 53, Line 15insufficient revenues from the healthcare affordability and sustainability

• Page 53, Line 16hospital provider fee cash fund, created in section 25.5-4-402.4, for the

• Page 53, Line 17administrative expenses associated with preparing and submitting the

• Page 53, Line 18state plan amendments. If there are insufficient revenues from the

• Page 53, Line 19healthcare affordability and sustainability hospital provider fee cash

• Page 53, Line 20fund, the state department may accept and expend gifts, grants, or donations for this purpose.

• Page 53, Line 21SECTION 16.  In Colorado Revised Statutes, 25.5-8-103, amend (4)(a)(II) and (4)(b)(II) as follows:

• Page 53, Line 2225.5-8-103.  Definitions - rules. As used in this article 8, unless

• Page 53, Line 23the context otherwise requires:

• (4)  "Eligible person" means:

• Page 54, Line 1(a) (II)  Notwithstanding the provisions of subsection (4)(a)(I) of

• Page 54, Line 2this section, if the money in the healthcare affordability and sustainability

• Page 54, Line 3hospital provider fee cash fund established pursuant to section

• Page 54, Line 425.5-4-402.4 (5), together with the corresponding federal matching funds,

• Page 54, Line 5is insufficient to fully fund all of the purposes described in section

• Page 54, Line 625.5-4-402.4 (5)(b), after receiving recommendations from the Colorado

• Page 54, Line 7healthcare affordability and sustainability enterprise established pursuant

• Page 54, Line 8to section 25.5-4-402.4 (3), for persons less than nineteen years of age,

• Page 54, Line 9the state board may by rule adopted pursuant to the provisions of section

• Page 54, Line 1025.5-4-402.4 (6)(b)(III) reduce the percentage of the federal poverty line

• Page 54, Line 11to below two hundred sixty percent, but the percentage shall not be reduced to below two hundred thirteen percent.

• Page 54, Line 12(b) (II)  Notwithstanding the provisions of subsection (4)(b)(I) of

• Page 54, Line 13this section, if the money in the healthcare affordability and sustainability

• Page 54, Line 14hospital provider fee cash fund established pursuant to section

• Page 54, Line 1525.5-4-402.4 (5), together with the corresponding federal matching funds,

• Page 54, Line 16is insufficient to fully fund all of the purposes described in section

• Page 54, Line 1725.5-4-402.4 (5)(b), after receiving recommendations from the Colorado

• Page 54, Line 18healthcare affordability and sustainability enterprise established pursuant

• Page 54, Line 19to section 25.5-4-402.4 (3), for pregnant women, the state board by rule

• Page 54, Line 20adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III) may

• Page 54, Line 21reduce the percentage of the federal poverty line to below two hundred

• Page 54, Line 22sixty percent, but the percentage shall not be reduced to below two hundred thirteen percent.

• Page 54, Line 23SECTION 17. Appropriation - adjustments to 2025 long bill.

• Page 54, Line 24(1)  To implement this act, appropriations made in the annual general

• Page 55, Line 1appropriation act for the 2025-26 state fiscal year to the department of

• Page 55, Line 2health care policy and financing from the Medicaid nursing facility cash

• Page 55, Line 3fund created in section 25.5-6-203 (2)(a), C.R.S., are decreased as follows:

• Page 55, Line 4Executive director's office, general administration

• Personal services$246,811

• Page 55, Line 5Health, life, and dental$30,953

• Short-term disability$65

• Page 55, Line 6Paid family and medical leave insurance$1,153

• Unfunded liability amortization equalization

• Page 55, Line 7disbursement payments$15,605

• Salary survey$6,899

• Page 55, Line 8Step pay$461

• PERA direct distribution$5,026

• Page 55, Line 9Workers' compensation$788

• Operating expenses$13,200

• Page 55, Line 10Payment to risk management and property funds$772

• Leased space$17,191

• Page 55, Line 11Payments to OIT$59,513

• CORE operations$123

• Page 55, Line 12General professional services and special projects$1,250

• Page 55, Line 13Executive director's office, utilization and quality review contracts

• Page 55, Line 14Professional services contracts$36,875

• Executive director's office, provider audits and services

• Page 55, Line 15Professional audit contracts$12,420

• Page 55, Line 16Executive director's office, indirect cost recoveries

• Indirect cost assessment$12,116

• Page 56, Line 1Medical services premiums

• Medical and long-term care services for Medicaid

• Page 56, Line 2eligible individuals$62,525,000

• Page 56, Line 3(2)  For the 2025-26 state fiscal year, $62,986,221 is appropriated

• Page 56, Line 4to the department of health care policy and financing. This appropriation

• Page 56, Line 5is from the healthcare affordability and sustainability nursing facility

• Page 56, Line 6provider fee cash fund created in section 25.5-4-402.4 (5.5)(a), C.R.S. To implement this act, the department may use this appropriation as follows:

• Page 56, Line 7Executive director's office, general administration

• Personal services$246,811

• Page 56, Line 8Health, life, and dental$30,953

• Short-term disability$65

• Page 56, Line 9Paid family and medical leave insurance$1,153

• Unfunded liability amortization equalization

• Page 56, Line 10disbursement payments$15,605

• Salary survey$6,899

• Page 56, Line 11Step pay$461

• PERA direct distribution$5,026

• Page 56, Line 12Workers' compensation$788

• Operating expenses$13,200

• Page 56, Line 13Payment to risk management and property funds$772

• Leased space$17,191

• Page 56, Line 14Payments to OIT$59,513

• CORE operations$123

• Page 56, Line 15General professional services and special projects$1,250

• Page 56, Line 16Executive director's office, utilization and quality review contracts

• Page 57, Line 1Professional services contracts$36,875

• Executive director's office, provider audits and services

• Page 57, Line 2Professional audit contracts$12,420

• Executive director's office, indirect cost recoveries

• Page 57, Line 3Indirect cost assessment$12,116

• Medical services premiums

• Page 57, Line 4Medical and long-term care services for Medicaid

• eligible individuals$62,525,000

• Page 57, Line 5(3)  To implement this act, appropriations made in the annual general

• Page 57, Line 6appropriation act for the 2025-26 state fiscal year to the department of

• Page 57, Line 7health care policy and financing from the service fee fund created in section 25.5-6-204 (1)(c)(II), C.R.S., are decreased as follows:

• Page 57, Line 8Executive director's office, general administration

• Personal services$36,476

• Page 57, Line 9Health, life, and dental$4,955

• Short-term disability$15

• Page 57, Line 10Paid family and medical leave insurance$169

• Unfunded liability amortization equalization

• Page 57, Line 11disbursement payments$2,287

• Salary survey$1,150

• Page 57, Line 12Step pay$67

• PERA direct distribution$737

• Page 57, Line 13Workers' compensation$116

• Operating expenses$1,876

• Page 57, Line 14Payment to risk management and property funds$114

• Page 57, Line 15Leased space$2,371

• Payments to OIT$8,789

• Page 58, Line 1CORE operations$18

• Executive director's office, indirect cost recoveries

• Page 58, Line 2Indirect cost assessment$1,778

• Medical services premiums

• Page 58, Line 3Medical and long-term care services for Medicaid

• eligible individuals$200,460

• Page 58, Line 4Transfers to other state department Medicaid-funded programs, human services

• Page 58, Line 5Regional centers for people with developmental

• disabilities$1,888,903

• Page 58, Line 6(4)  For the 2025-26 state fiscal year, $2,150,281 is appropriated to the

• Page 58, Line 7department of health care policy and financing. This appropriation is from

• Page 58, Line 8the healthcare affordability and sustainability intermediate care facility

• Page 58, Line 9fee cash fund created in section 25.5-4-402.4 (5.7)(a), C.R.S. To implement this act, the department may use this appropriation as follows:

• Page 58, Line 10Executive director's office, general administration

• Personal services$36,476

• Page 58, Line 11Health, life, and dental$4,955

• Short-term disability$15

• Page 58, Line 12Paid family and medical leave insurance$169

• Unfunded liability amortization equalization

• Page 58, Line 13disbursement payments$2,287

• Salary survey$1,150

• Page 58, Line 14Step pay$67

• PERA direct distribution$737

• Page 58, Line 15Workers' compensation$116

• Operating expenses$1,876

• Page 59, Line 1Payment to risk management and property funds$114

• Leased space$2,371

• Page 59, Line 2Payments to OIT$8,789

• CORE operations$18

• Page 59, Line 3Executive director's office, indirect cost recoveries

• Indirect cost assessment$1,778

• Page 59, Line 4Medical services premiums

• Medical and long-term care services for Medicaid

• Page 59, Line 5eligible individuals$200,460

• Page 59, Line 6Transfers to other state department Medicaid-funded programs, human services

• Page 59, Line 7Regional centers for people with developmental

• disabilities$1,888,903

• Page 59, Line 8SECTION 18.  Effective date. This act takes effect May 1, 2025.

• Page 59, Line 9SECTION 19.  Safety clause. The general assembly finds,

• Page 59, Line 10determines, and declares that this act is necessary for the immediate

• Page 59, Line 11preservation of the public peace, health, or safety or for appropriations for

• Page 59, Line 12the support and maintenance of the departments of the state and state institutions.