→
Previous
Latest
NOTE:
This bill has been prepared for the signatures of the appropriate legislative officers and the Governor.
To determine whether the Governor has signed the bill or taken other action on it, please consult the legislative status sheet, the legislative history, or the Session Laws.
C ONCERNING HEALTH -CARE PAYMENT PROGRAMS .
CONCERNING HEALTH-CARE PAYMENT PROGRAMS.
Be it enacted by the General Assembly of the State of Colorado:
Be it enacted by the GeneralAssembly ofthe State ofColorado:
Providers-hospitalreimbursement-hospitalreview program - rules.
Providers-hospital reimbursement-hospital review program - rules.
(3) (a) (I) In addition to the reimbursement rate process described in subsection (1) of this section and subject to FEDERAL APPROVAL AND adequate funding being made available pursuant to section 25.5-4-402.4, the Colorado healthcare affordability and sustainability enterprise created in section 25.5-4-402.4 (3) shall pay an additional amount based upon performance IN THE HOSPITAL QUALITY INCENTIVE PROGRAM to those ________ Capital letters or bold & italic numbers indicate new material added to existing law;
(3) (a) (I) In addition to the reimbursement rate process described in subsection (1) of this section and subject tFEDERAL APPROVAL AND adequate funding being made available pursuant to section 25.5-4-402.4, the Colorado healthcare affordability and sustainability enterprise created in section 25.5-4-402.4 (3) shall pay an additional amount based upon performance IN THE HOSPITAL QUALITY INCENTIVE PROGRAM to those Capital letters or bold & italic numbers indicate new material added to existing law;
dashes through words or numbers indicate deletions from existing law and such material is not part of the act.
dashes through words or numbers indicate deletionsfrom existing law andsuch material is notpart of the act.
hospitals that provide services that improve health-care outcomes for their patients, includiDELIVER SAFER,MORE EFFECTIVE CARE THAT IMPROVES PATIENT OUTCOMES AND REDUCES PREVENTABLE UTILIZATION TO REDUCE HEALTH -CARE COSTS.
hospitals that provide set vices that improve hcalth-catc outcomes fut thcit patients, includiDELIVER SAFER, MORE EFFECTIVE CARE THAT IMPROVES PATIENT OUTCOMES AND REDUCES PREVENTABLE UTILIZATION TO REDUCE HEALTH-CARE COSTS.
The state department shall determine this amount based upon nationally recognized performance measures established in rules adopted bythe state board.
The state department shall dctctminc this amount based upon nationally tccognizcd pctfotmancc measures established in 1ulcs adopbythe state boatd.
The state quality standards must be consistent with federal quality standards published by an organization with expertise in health-care quality, including, but not limited to, the federal centers for medicareand medicaid services, the agency for healthcare research and quality, or the national quality forum.
The state quality standatds must be consistent with federal quality standatds published by an 01ganization with expertise in health-catc quality, including, but not limited to, the federal ccntcts fut medicate and mcdicaid set vices, the agency fut hcalthcatc rcscarch and quality, or the national quality forum.
(II) (A) PRIOR TO IMPLEMENTATION OF THE PROGRAM ,THE COLORADOHEALTHCAREAFFORDABILITYANDSUSTAINABILITYENTERPRISE BOARD SHALL APPROVE THE PERCENTAGE OF HOSPITALS 'REIMBURSEMENT IN THE HOSPITAL QUALITY INCENTIVE PROGRAM , PROGRAM STRUCTURE , PERFORMANCE MEASURES ,AND SCORING METHODOLOGY .
(II) (A) PRIOR TO IMPLEMENTATION OF THE PROGRAM, THE COLORADOHEALTHCAREAFFORDABILITYAND SUSTAINABILITYENTERPRISE BOARD SHALL APPROVE THE PERCENTAGE OF HOSPITALS' REIMBURSEMENT IN THE HOSPITAL QUALITY INCENTIVE PROGRAM, PROGRAM STRUCTURE, PERFORMANCE MEASURES, AND SCORING METHODOLOGY.
(B) W HEN APPROVING A PROGRAM PURSUANT TO THIS SUBSECTION (3)(a)THE BOARD SHALL REQUIRE THAT NEW MEASURES REMAIN IN PLACE FOR A DEFINED PERIOD OF TIME NOT TO EXCEED THREE YEARS PRIOR TO MODIFICATIONORREPLACEMENTOFTHENEWMEASURES ;EXCEPTTHATTHE BOARDMAYAPPROVEMODIFICATIONSORREPLACEMENTSPRIORTOTHEEND OFTHEDEFINEDPERIODOFTIMEIFTHEBOARDISPRESENTEDWITHEVIDENCE THAT THE APPROVED MEASURES ARE NOT MEETING THE GOALS OF THE PROGRAM OR REQUIRE TECHNICAL ADJUSTMENTS .
(B) WHEN APPROVING A PROGRAM PURSUANT TO THIS SUBSECTION (3)(a)THE BOARD SHALL REQUIRE THAT NEW MEASURES REMAIN IN PLACE FOR A DEFINED PERIOD OF TIME NOT TO EXCEED THREE YEARS PRIOR TO MODIFICATIONORREPLACEMENTOFTHENEWMEASURES;EXCEPTTHATTHE BOARD MAY APPROVE MODIFICATIONS ORREPLACEMENTS PRIORTOTHE END OFTHE DEFINEDPERIODOFTIMEIFTHE BOARD ISPRESENTED WITH EVIDENCE THAT THE APPROVED MEASURES ARE NOT MEETING THE GOALS OF THE PROGRAM OR REQUIRE TECHNICAL ADJUSTMENTS.
N OTHING IN THIS SUBSECTION (3)(a)PRECLUDES THE BOARD FROM RENEWING MEASURES THAT MEET THE GOALS OF THE PROGRAM AFTER THE DEFINED PERIOD OF TIME NOT TO EXCEED THREE YEARS HAS EXPIRED .
NOTHING IN THIS SUBSECTION (3)(a)PRECLUDES THE BOARD FROM RENEWING MEASURES THAT MEET THE GOALS OF THE PROGRAM AFTER THE DEFINED PERIOD OF TIME NOT TO EXCEED THREE YEARS HAS EXPIRED.
(C) A NY MODIFICATIONS TO THE HOSPITAL QUALITY INCENTIVE PROGRAM MUST BE APPROVED BY THE BOARD PRIOR TO IMPLEMENTATION ;
(C) ANY MODIFICATIONS TO THE HOSPITAL QUALITY INCENTIVE PROGRAM MUST BE APPROVED BY THE BOARD PRIOR TO IMPLEMENTATION;
EXCEPTTHATCHANGESNECESSARYTOCOMPLYWITHFEDERALLAWMAYBE IMPLEMENTED IMMEDIATELY .
EXCEPTTHATCHANGES NECESSARYTOCOMPLY WITH FEDERALLAW MAY BE IMPLEMENTED IMMEDIATELY.
(III) PERFORMANCE MEASURES AND METHODOLOGIES MUST BE BASED ON FACTORS THAT ARE REASONABLY WITHIN HOSPITALS 'CONTROL , ALIGNED WITH NATIONALLY RECOGNIZED STANDARDS TO THE MAXIMUM EXTENT PRACTICABLE , AND DESIGNED TO MINIMIZE ADMINISTRATIVE PAGE 2-HOUSE BILL 26-1432 BURDEN , INCLUDING BY AVOIDING DUPLICATIVE REPORTING AND LEVERAGING EXISTING DATA SOURCES WHEN POSSIBLE .
(Ill) PERFORMANCE MEASURES AND METHODOLOGIES MUST BE BASED ON FACTORS THAT ARE REASONABLY WITHIN HOSPITALS' CONTROL, ALIGNED WITH NATIONALLY RECOGNIZED STANDARDS TO THE MAXIMUM EXTENT PRACTICABLE, AND DESIGNED TO MINIMIZE ADMINISTRATIVE PAGE 2-HOUSE BILL 26-1432 BURDEN, INCLUDING BY AVOIDING DUPLICATIVE REPORTING AND LEVERAGING EXISTING DATA SOURCES WHEN POSSIBLE.
THE HOSPITAL QUALITY INCENTIVE PROGRAM SHOULD ALIGN WITH FEDERAL QUALITY STANDARDS .
THE HOSPITAL QUALITY INCENTIVE PROGRAM SHOULD ALIGN WITH FEDERAL QUALITY STANDARDS.
(b) (I) The amount of the payments made pursuant to subsection (3)(a) of this section must be computedannually.Foreachstatefiscalyear, thetotalamountof thepaymentsmustbenomorethansevenpercentofthe total reimbursements made to hospitals in the previous state fiscal year.
(b) (I) The amount of the payments made pursuant to subsection (3)(a) ofthis section must be computed annually.
(II) NTWITHSTANDINGSUBSECTION (3)(b)(OFTHISSECTION THE MAXIMUM PERCENTAGE OF PAYMENTS MUST NOT EXCEED SEVEN PERCENT OF THE TOTAL REIMBURSEMENTS MADE TO HOSPITALS IN THE PREVIOUS STATE FISCAL YEAR UNLESS AND UNTIL THE C OLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY ENTERPRISE BOARD FORMALLY APPROVES A HOSPITAL QUALITY INCENTIVE PROGRAM PURSUANT TO SUBSECTION (3)(a)OF THIS SECTION , DEVELOPED WITH INPUT FROM HOSPITAL REPRESENTATIVES WITH CLINICAL EXPERTISE,AFTER WHICH THE MAXIMUMPERCENTAGE OFPAYMENTSMUST NOT EXCEEDNINE PERCENT OF THE TOTAL REIMBURSEMENTS MADE TO HOSPITALS .
For each state fiscal year, the total amount ofthe payments must be no more than sevenpercent ofthe total reimbursements made to hospitals in the previous state fiscal year.
(IINOTWITHSTANDING SUBSECTION (3)(b)(1OFTHIS SECTION,THE MAXIMUM PERCENTAGE OF PAYMENTS MUST NOT EXCEED SEVEN PERCENT OF THE TOTAL REIMBURSEMENTS MADE TO HOSPITALS IN THE PREVIOUS STATE FISCAL YEAR UNLESS AND UNTIL THE COLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY ENTERPRISE BOARD FORMALLY APPROVES A HOSPITAL QUALITY INCENTIVE PROGRAM PURSUANT TO SUBSECTION (3)(a)OF THIS SECTION, DEVELOPED WITH INPUT FROM HOSPITAL REPRESENTATIVES WITH CLINICAL EXPERTISE, AFTER WHICH THE MAXIMUM PERCENTAGE OF PAYMENTS MUSTNOT EXCEED NINE PERCENT OF THE TOTAL REIMBURSEMENTS MADE TO HOSPITALS.
In Colorado Revised Statutes, 25.5-4-402.4, amend (4)(a)(IV)(E), (4)(c)(I) introductory portion, (5)(b)(VIII), (7)(d)(V), and (7)(e)(VI);
In Colorado Revised Statutes, 25.5-4-402.4amend (4)(a)(IV)(E), (4)(c)(I) introductory portion, (5)(b)(VIII), (7)(d)(V), and (7)(e)(VI);
and repeal (8) as follows:
andrepeal(8) as follows:
Hospitals - healthcare affordability and sustainability hospital provider fee - healthcare affordability and sustainability nursing facility provider fee - healthcare affordability andsustainabilityintermediatecarefacilityfee-receiptofpublicfunds - Colorado healthcare affordability and sustainability enterprise - federal waiver - funds created - reports - rules - legislative declaration - definitions - repeal.
Hospitals - healthcare affordability and sustainability hospital provider fee - healthcare affordability and sustainability nursing facility provider fee - healthcare affordability andsustainabilityintermediate carefacilityfee -receiptofpublicfunds - Colorado healthcare affordability and sustainability enterprise - federal waiver - funds created - reports - rules - legislative declaration - definitions - repeal.
(4) Healthcareaffordabilityandsustainabilityhospitalprovider fee.
(4)Healthcareaffordabilityandsustainability hospital provider fee.
(a) For the fiscal year commencing July1, 2017, and for each fiscal year thereafter, the enterprise is authorized to charge and collect a healthcareaffordabilityandsustainabilityhospitalproviderfee,asdescribed in 42 CFR 433.68 (b), or as otherwise in compliance with 42 CFR 433, on PAGE 3-HOUSE BILL 26-1432 outpatient and inpatient services provided by all licensed or certified hospitals, and receive public funds as described in 42 CFR 433.51, for the purpose of obtainingfederal financial participation under the state medical assistance program as described in this article 4 and articles 5 and 6 of this title25.5,includingdisproportionatesharehospitalpaymentspursuantto42 U.S.C.
(a) Forthe fiscal year commencing July 1, 2017, and for each fiscal year thereafter, the enterprise is authorized to charge and collect a healthcareaffordabilityandsustainabilityhospitalproviderfee, asdescribed in 42 CFR 433.68 (b), or as otherwise in compliance with 42 CFR 433, on PAGE 3-HOUSE BILL 26-1432 outpatient and inpatient services provided by all licensed or certified hospitals, and receive public funds as described in 42 CFR 433.51, for the purpose ofobtaining federal financial participation under the state medical assistance program as described in this article 4 and articles 5 and 6 ofthis title25.5,includingdisproportionatesharehospitalpaymentspursuantto42 U.S.C.
If the amount of hospital provider fee revenue collectedexceedsthefederalnetpatientrevenue-basedlimitontheamount of such fee revenue that may be collected, requiring repayment to the federal government of excess federal matching money received, hospitals that received such excess federal matching money are responsible for repaying the excess federal money and any associated federal penalties to the federal government.
If the amount of hospital provider fee revenue collectedexceeds the federal netpatientrevenue-based limit onthe amount of such fee revenue that may be collected, requiring repayment to the federal government ofexcess federal matching money received, hospitals that received such excess federal matching money are responsible for repaying the excess federal money and any associated federal penalties to the federal government.
(E) Providing funding for, and in cooperation with the state department and hospitals supporting the implementation of a health-care delivery system reform incentive payments program as described in subsection (8) of this sectioTHE HOSPITAL QUALITY INCENTIVE PROGRAM CREATED IN SECTION 25.5-4-402 (3)(a).
(E) Providing funding for, and in cooperation with the state department and hospitals supporting the implementation of a health-care delivery system reform incentive payments prngranr as described in subsection (8) ofthis sectionTHE HOSPITAL QUALITY INCENTIVE PROGRAM CREATED IN SECTION 25.5-4-402 (3)(a).
(c) (I) In accordance with the redistributive method set forth in 42 CFR 433.68 (e)(1) and (e)(2), the enterprise, acting in concert with or through an agreement with the state department if required by federal law, mayseek a waiver from the broad-based hospital provider fee requirement or the uniform hospital provider fee requirement, or both.
(c) (I) In accordance with the redistributive method set forth in 42 CFR 433.68 (e)(l) and (e)(2), the enterprise, acting in concert with or through an agreement with the state department ifrequired by federal law, may seek a waiver from the broad-based hospital provider fee requirement or the uniform hospital provider fee requirement, or both.
In addition, the enterprise, acting in concert with or through an agreement with the state department if required by federal law, shall seek any federal waiver necessary to fund and, in cooperation with the state department and hospitals, support the implementation of a health-care delivery system reform incentive payments program as described in subsection (8) of this section.Subjecttofederalapprovalandtominimizethefinancialimpacton certain hospitals, the enterprise may exempt from payment of the hospital provider fee certain types of hospitals, including but not limited to:
In addition, the entetptise, acting in concert (\iit01 thrnugh an agreement with the state department if required by federal law, shall seek any federal waiver necessary to fund and, in cooperation with the state department and hospitals, support the implementation of a health-eate deliv cry system reform incentive payments prngram as described in subsection (8) ofthis section.
(5) Healthcareaffordabilityandsustainabilityhospitalprovider fee cash fund.
Subjectto federal approval andto minimizethe financial impact on certain hospitals, the enterprise may exempt from payment ofthe hospital provider fee certain types ofhospitals, including but not limited to:
PAGE 4-HOUSE BILL 26-1432 (b) All money in the hospital provider fee cash fund is subject to federal matching as authorized under federal law and, subject to annual appropriation bythe general assembly, shall be expended bythe enterprise for the following purposes:
(5) Healthcareaffordabilityand sustainability hospitalprovider fee cash fund.
(VIII) Subject to any necessary federal waivers being obtained, to provide funding for a health-care delivery system reform incentive paymentsprogramasdescribedinsubsection(8)ofthissectionS UBJECTTO FEDERAL APPROVAL ,FOR THE HOSPITAL QUALITY INCENTIVE PROGRAM DESCRIBED IN SECTION 25.5-4-402 (3);
PAGE 4-HOUSE BILL 26-1432 (b) All money in the hospital provider fee cash fund is subject to federal matching as authorized under federal law and, subject to annual appropriation by the general assembly, shall be expended by the enterprise for the following purposes:
(VIII) Subject to any necessary federnl waivers being obtained, to provide funding for a health-care delivery system 1eform incentive payments progrnm as desetibed in subsection(8) ofthis section SUBJECTTO FEDERAL APPROVAL, FOR THE HOSPITAL QUALITY INCENTIVE PROGRAM DESCRIBEDINSECTION25.5-4-402 (3);
(V) To direct and oversee the enterprise in seeking, in concert with or through an agreement with the state department if required by federal law,anyfederalwaivernecessarytofundand,incooperationwiththestate department and hospitals, support the implementation of a health-care delivery system reform incentive payments program as described in subsection (8) of this sectiTHE HOSPITAL QUALITY INCENTIVE PROGRAM CREATED IN SECTION 25.5-4-402 (3)(a);
(V) To direct and oversee the enterprise in seeking, in concert with or through an agreement with the state department if required by federal law, any federal waiver necessary to fund and, in cooperation with the state department and hospitals, support the implementation of a health-eate delivery system 1efo1m incentive payments progrnm as desetibed in subsection (8) ofthis section THEHOSPITALQUALITYINCENTIVEPROGRAM CREATEDINSECTION25.5-4-402 (3)(a);
(e) OnorbeforeJanuary15,2018,andonorbeforeJanuary15each year thereafter, the enterprise board shall submit a written report to the health and human services committee of the senate and the health and humanservicescommitteeofthehouseofrepresentatives,oranysuccessor committees, the joint budget committee of the general assembly, the governor, and the state board.
(e) On or beforeJanuary 15, 2018, and on orbefore January 15 each year thereafter, the enterprise board shall submit a written report to the health and human services committee of the senate and the health and human services committee ofthe house ofrepresentatives, orany successor committees, the joint budget committee of the general assembly, the governor, and the state board.
(A) The efforts made by the enterprise acting in concert with or through an agreement with the state department if required byfederal law, to seek any federal waiver necessary to fund and, in cooperation with the statedepartmentandhospitals,supporttheimplementationofahealth-care delivery system reform incentive payments program as described in subsection (8) of this section TO IMPLEMENT THE HOSPITAL QUALITY PAGE 5-HOUSE BILL 26-1432 INCENTIVE PROGRAM REQUIRED PURSUANT TO SECTION 25.5-4-402 (3), INCLUDINGINFORMATIONABOUTTHESTRUCTUREOFTHEHOSPITALQUALITY INCENTIVE PROGRAM AND ANY RESULTS ACHIEVED AS A RESULT OF THE HOSPITAL QUALITY INCENTIVE PROGRAM ;
(A) The efforts made by the enterprise acting in concert with m through an agteement with the state department iftequited by federnl law, to seek any fedetal waivet necessary to fund and, in eoopetation with the state department and hospitals, supportthe implementation ofa health-eate delivery system 1efo1m incentive payments progrnm as desetibed in subsection (8) of this section TO IMPLEMENT THE HOSPITAL QUALITY PAGE 5-HOUSE BILL 26-1432 INCENTIVE PROGRAM REQUIRED PURSUANT TO SECTION 25.5-4-402 (3), INCLUDINGINFORMATIONABOUTTHESTRUCTUREOFTHEHOSPITALQUALITY INCENTIVE PROGRAM AND ANY RESULTS ACHIEVED AS A RESULT OF THE HOSPITAL QUALITY INCENTIVE PROGRAM;
and (B) The progress actually made by the enterprise, in cooperation with the state department and hospitals, towards the goal of implementing such a program AND THE ENTERPRISE BOARD 'S LEGISLATIVE RECOMMENDATIONS FOR CHANGES TO THE HOSPITAL QUALITY INCENTIVE PROGRAM .
and (B) The progress actually made by the enterprise, in cooperation with the state department and hospitals, towards the goal of implementing such a program AND THE ENTERPRISE BOARD'S LEGISLATIVE RECOMMENDATIONS FOR CHANGES TO THE HOSPITAL QUALITY INCENTIVE PROGRAM.
(8) Health-care delivery system reform incentive payments program-fundingandimplementation.Theenterprise,actinginconcert with or through an agreement with the state department if required by federal law, shall seek any federal waiver necessary to fund and, in cooperation with the state department and hospitals, support the implementation, no earlier than October 1, 2019, of a health-care delivery system reform incentive payments program that will improve health-care access and outcomes for individuals served by the state department while efficiently utilizing available financial resources.
(8) Ilealth-ca1e deli\1e1-, system Iefo11n incenti\1e payments prog1a111- funding and implementation.
Such a program must, at a minimum:
The ente1p1ise, acting in conccrt with m through an agreement with the state departinent if required by federal law, shall seek any federal waiver necessary to fund and, in cooperation with the state department and hospitals, support the implementation, no earlier than October 1, 2019, ofa health-care delivery system refunn incentive payments program that will improve health-care access and outcomes fur individuals setved by the state department while efficiently utilizing available financial resomces.
Show all 54 changed rows (14 more)
Previous
Latest
(a) Include an initial planning phase to:
Such a program must, at a mtn1mmn:
(I) Assess needs;
(a) Include an initial planning phase to.
and (II) Develop achievable outcome-based metrics to be used to measureprogresstowardsprogramgoals,includingthegoalsofhealth-care deliverysystemintegration,improvedpatientoutcomes,andmoreefficient provision of care;
(I) Assess needs, and (II) Devclop achievable outco1ne-based met1ics to be used to measmeprogtesstowardsprogratngoals, includingthe goals ofhealth-care delivcry system integration, impO'Vedpatientoutcomes, and more efficient prO'Vision ofcare, and (b) Addiess the fullowing focus ateas:
and (b) Address the following focus areas:
(I) Care coordination and care transition management, (II) Integration ofph)isieal and behavioral health-care set vices, (III) Chronic condition nranagement, (IV) Targeted population health, and PAGE 6-HOUSE BILL 26-1432 (V) Data-diiven accountability and outcome measurement.
(I) Care coordination and care transition management;
(II) Integration of physical and behavioral health-care services;
(III) Chronic condition management;
(IV) Targeted population health;
and PAGE 6-HOUSE BILL 26-1432 (V) Data-driven accountability and outcome measurement.
Safety clause.
Safety clause.The general assembly finds, determines, and declares that this act is necessary for the immediate preservation ofthe public peace, health, or safety or for appropriations for the support and maintenance of the departments of the state and state institutions.
The general assembly finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, or safety or for appropriations for the support and maintenance of the departments of the state and state institutions.
J u l i ~ " - - .
____________________________ ____________________________ Julie McCluskie James Rashad Coleman, Sr.
_ _ James Rashad Coleman, Sr.
SPEAKER OF THE HOUSE PRESIDENT OF OF REPRESENTATIVES THE SENATE ____________________________ ____________________________ Vanessa Reilly Esther van Mourik CHIEF CLERK OF THE HOUSE SECRETARY OF OF REPRESENTATIVES THE SENATE APPROVED________________________________________ (Date and Time) _________________________________________ Jared S.
SPEAKER OF THE HOUSE PRESIDENT OF OF REPRESENTATIVES THE SENATE Vanessa Reilly Esther van Mourik CHIEF CLERK OF THE HOUSE SECRETARY OF OF REPRESENTATIVES THE SENATE APPROVED o \N .--4h ».2.--v C\,+ 1c:~ a rrv't and Time) DO PAGE 7-HOUSE BILL 26-1432
Polis GOVERNOR OF THE STATE OF COLORADO PAGE 7-HOUSE BILL 26-1432
⬇ Download PDF