A Bill for an Act
Page 1, Line 101Concerning changes to the 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 exempts an assisted living residence with fewer than 19 beds that has not undergone new construction or renovations and that complies with the standards for assisted living residences from complying with facility guidelines adopted by the state board of health.
The bill requires the department of health care policy and financing (state department) to follow the standards set by the federal centers for medicare and medicaid when updating rules.
The state department must establish a process for reviewing and updating the general billing manual on an annual basis and ensure that the general billing manual includes all necessary CPT codes.
Beginning January 1, 2026, for claims that must be reprocessed as a result of updating the provider rates, the bill requires a managed care organization to issue payment to a contracted provider within one year after the provider rate is updated.
The bill requires the state department to include in each new contract with, or renewal of a contract with, a managed care entity (MCE) a provision requiring the MCE to submit to the state department, on an annual basis, the amount the MCE is paid and the MCE's medical loss ratio. The state department is required to publish this information on the state department's website on an annual basis.
The bill prohibits the state department from imposing signature requirements on a physician or practitioner certifying a medicaid member's (member) plan of care that involves physical therapy or occupational therapy.
The bill prevents a member receiving home- and community-based services from losing the services the member currently receives if the member's disability and need for services have not changed in the preceding 3 years.
This Unofficial Version Includes Committee
Amendments Not Yet Adopted on Second Reading
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. In Colorado Revised Statutes, 25-27-104, add (3) as follows:
Page 2, Line 325-27-104. Minimum standards for assisted living residences
Page 2, Line 4- rules - definition. (3) (a) Rules adopted by the state board
Page 2, Line 5pursuant to subsection (1) of this section must exempt an
Page 2, Line 6assisted living residence with fewer than nineteen beds from
Page 2, Line 7complying with the facility guideline institute (FGI) guidelines,
Page 2, Line 8except in the case of new construction or major renovations. An
Page 2, Line 9assisted living residence with fewer than nineteen beds must still comply with all other standards outlined in this section.
Page 2, Line 10(b) For purposes of subsection (3)(a) of this section, "major
Page 2, Line 11renovations" means additions to a building's structure or
Page 2, Line 12changes that affect the structural integrity of the building.
Page 3, Line 1Major renovations do not include changing the functional
Page 3, Line 2operation of a space if no construction is completed and the
Page 3, Line 3floor plan of the building remains the same. It also does not
Page 3, Line 4include adding beds to accommodate more residents or upgrades
Page 3, Line 5to the heating or cooling systems and electrical systems if
Page 3, Line 6those improvements do not require construction, comply with
Page 3, Line 7all other standards outlined in this section, and are approved through local permitting and fire safety.
Page 3, Line 8SECTION 2. In Colorado Revised Statutes, add 25.5-1-135 as follows:
Page 3, Line 925.5-1-135. Billing manual.Using existing resources
Page 3, Line 10allocated for billing manual reviews, the state department
Page 3, Line 11shall establish a process to review and update the general
Page 3, Line 12billing manual on an annual basis, which must ensure that the
Page 3, Line 13general billing manual includes all necessary CPT codes, or provides links to the state department's list of CPT codes.
Page 3, Line 15SECTION 3. In Colorado Revised Statutes, 25.5-5-402, add (7.5)(c) as follows:
Page 3, Line 1625.5-5-402. Statewide managed care system - rules -
Page 3, Line 17definitions.(7.5) (c) (I) Beginning January 1, 2026, for a claim that
Page 3, Line 18must be reprocessed as a result of updating the provider rates,
Page 3, Line 19an MCO shall issue payment to the contracted provider within one year after the provider rate is updated.
Page 3, Line 20(II) The state department shall notify the MCOs of any
Page 3, Line 21change to the provider rates within sixty days of changing the
Page 3, Line 22provider rates.
Page 4, Line 1SECTION 4. In Colorado Revised Statutes, add 25.5-5-427 as follows:
Page 4, Line 225.5-5-427. Managed care entities - disclosure of payment and
Page 4, Line 3medical loss ratio - definition. (1) The state department shall
Page 4, Line 4include in each new contract with, or renewal of a contract
Page 4, Line 5with, an MCE a provision requiring the MCE to submit to the
Page 4, Line 6state department, on an annual basis, the amount the MCE is paid for delivering services and the MCE's medical loss ratio.
Page 4, Line 7(2) The state department shall annually publish the following information on its website:
Page 4, Line 8(a) The information received pursuant to subsection (1) of this section;
Page 4, Line 9(b) Historical medial loss ratio data for each MCE; and
Page 4, Line 10(c) Audit findings regarding an MCE's most recently completed medical loss ratio audit.
Page 4, Line 11(3) For purposes of subsection (1) of this section, "medical
Page 4, Line 12loss ratio" means the percentage of premium revenue that the
Page 4, Line 13MCE spends on health-care services and quality improvement activities.
Page 4, Line 14SECTION 5. In Colorado Revised Statutes, add 25.5-6-117 as follows:
Page 4, Line 1525.5-6-117. Plan of care - rehabilitation therapy -
Page 4, Line 16requirements - definition. (1) As used in the section, unless the
Page 4, Line 17context otherwise requires, "plan of care" has the same meaning as set forth in section 25.5-6-403.
Page 4, Line 18(2) The state department shall not impose signature
Page 4, Line 19requirements beyond what is required by the federal centers for
Page 5, Line 1medicare and medicaid services pursuant to 42 CFR 409.43 on a
Page 5, Line 2physician or practitioner certifying a member's plan of care that
Page 5, Line 3involves physical therapy, occupational therapy, or speech therapy services.
Page 5, Line 4SECTION 6. In Colorado Revised Statutes, add 25.5-6-118 as follows:
Page 5, Line 525.5-6-118. Long-term care for members with permanent
Page 5, Line 6disability. (1) For a member receiving services through a
Page 5, Line 7long-term care program pursuant to parts 3 to 10 of this article
Page 5, Line 86, if a service the member receives is discontinued or is no longer
Page 5, Line 9a covered service, the state department must confirm the
Page 5, Line 10timeline for continuity of treatment with the federal centers
Page 5, Line 11for medicare and medicaid during the transition period of the
Page 5, Line 12benefit or service being discontinued. Upon confirmation, the
Page 5, Line 13state department shall communicate the timeline to the member impacted by the benefit or service being discontinued.
Page 5, Line 14(2) This section applies to members who are functionally
Page 5, Line 15and financially eligible to receive long-term care services pursuant to parts 3 to 10 of this article 6.
Page 5, Line 16SECTION 7. Act subject to petition - effective date. This act
Page 5, Line 17takes effect at 12:01 a.m. on the day following the expiration of the
Page 5, Line 18ninety-day period after final adjournment of the general assembly; except
Page 5, Line 19that, if a referendum petition is filed pursuant to section 1 (3) of article V
Page 5, Line 20of the state constitution against this act or an item, section, or part of this
Page 5, Line 21act within such period, then the act, item, section, or part will not take
Page 5, Line 22effect unless approved by the people at the general election to be held in
Page 6, Line 1November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.