A Bill for an Act
Page 1, Line 101Concerning redetermination of eligibility for individuals
Page 1, Line 102enrolled in the state medical assistance program.
Bill Summary
(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)
The bill authorizes the department of health care policy and financing (state department) to seek federal authorization to:
- Extend the timeline for member reenrollment in the state medical assistance program based on the financial eligibility for a member whose income is based solely on a fixed income source; and
- Verify a member's eligibility for reenrollment based on income and need at the same time.
The bill requires the state department to modify the questions asked to medical professionals when verifying a member's need for long-term services and supports and allows any licensed medical professional who has a bona fide physician-patient relationship with a member to complete the documentation necessary to verify a member's need for long-term services and supports.
The bill prohibits the state department from requiring new documentation for a member who transitions from receiving services in an institutional setting to receiving services in a home- and community-based setting and vice versa.
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. In Colorado Revised Statutes, 25.5-4-205, amend
Page 2, Line 3(3)(b)(I) introductory portion; and add (3)(b)(I.5)(H) and (3)(b)(I.5)(I) as follows:
Page 2, Line 425.5-4-205. Application - verification of eligibility -
Page 2, Line 5demonstration project - rules. (3) (b) (I) The state department shall
promulgatePage 2, Line 6(I.5) (H) The state department shall extend the timeline
Page 2, Line 7for reenrollment based on the financial eligibility for a member
Page 2, Line 8whose income consists solely of disability income or another
Page 2, Line 9source of fixed income from one year to three years, or as
Page 2, Line 10approved by the federal government. The state department
Page 2, Line 11shall seek any necessary federal authorization to implement this subsection (3)(b)(I.5)(H).
Page 2, Line 12(I) If the date of a member's reenrollment verification
Page 2, Line 13based on the member's income occurs within sixty days after the
Page 2, Line 14date of the member's reenrollment verification based on the
Page 2, Line 15member's need for services, the state department must conduct
Page 2, Line 16the reenrollment verification based on the member's income on
Page 3, Line 1the date that aligns with the date of the member's reenrollment
Page 3, Line 2verification based on the member's need for services. The state
Page 3, Line 3department shall seek any necessary federal authorization to implement this subsection (3)(b)(I.5)(I).
Page 3, Line 4SECTION 2. In Colorado Revised Statutes, add 25.5-6-117 as follows:
Page 3, Line 525.5-6-117. Determination of need-based services -
Page 3, Line 6professional medical information page - definition. (1) As used in
Page 3, Line 7this section, unless the context otherwise requires,
Page 3, Line 8"professional medical information page" means documented
Page 3, Line 9medical information signed by a licensed medical professional
Page 3, Line 10and used as a component of the assessment that determines a member's need for long-term services and supports.
Page 3, Line 11(2) On or before January 1, 2026, the state department
Page 3, Line 12shall modify the professional medical information page used to
Page 3, Line 13assess a member's need for long-term services and supports to
Page 3, Line 14reduce the number of medical questions required in the documentation that are obtained from medical professionals.
Page 3, Line 15(3) Any licensed medical professional who has a bona fide
Page 3, Line 16physician-patient relationship with a member may complete a professional medical information page for a member.
Page 3, Line 17(4) The state department shall not require a member to
Page 3, Line 18obtain a new professional medical information page when the
Page 3, Line 19member transitions from receiving services in an institutional
Page 3, Line 20setting to a home- and community-based setting or when the
Page 3, Line 21member transitions from receiving services in a home- and
Page 3, Line 22community-based setting to an institutional setting.
Page 4, Line 1SECTION 3. Act subject to petition - effective date. This act
Page 4, Line 2takes effect at 12:01 a.m. on the day following the expiration of the
Page 4, Line 3ninety-day period after final adjournment of the general assembly; except
Page 4, Line 4that, if a referendum petition is filed pursuant to section 1 (3) of article V
Page 4, Line 5of the state constitution against this act or an item, section, or part of this
Page 4, Line 6act within such period, then the act, item, section, or part will not take
Page 4, Line 7effect unless approved by the people at the general election to be held in
Page 4, Line 8November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.