Struck = removed from the bill ยท
added = the amendment's new text.
FirstSB270_H_APP.002 RegularNOT SessionAMENDED Seventy-fifthHOUSE GeneralCOMMITTEE Assembly STATE OF COLORADOREFERENCE ENGROSSEDREPORT This_______________________________ VersionApril Includes8, All2025 AmendmentsChair Adoptedof onCommittee SecondDate ReadingCommittee inon theAppropriations House. of Introduction LLS NO.
25-1037.01After Rebeccaconsideration Bayettion x4348the SENATEmerits, BILLthe 25-270Committee SENATErecommends SPONSORSHIPthe Bridgesfollowing: and Amabile, HOUSE SPONSORSHIP Bird and Sirota, Senate Committees House Committees Appropriations A BILL FOR AN ACT C ONCERNINGNURSINGFACILITYFEESCOLLECTEDBYTHE C OLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY ENTERPRISE ,AND ,IN CONNECTION THEREWITH ,AUTHORIZING THE ENTERPRISE TO PROVIDE ADDITIONAL SERVICES TO NURSING FACILITIES IN EXCHANGE FOR THE FEES COLLECTED AND MAKING AND REDUCING APPROPRIATIONS .
BillSB25-270 Summarybe (Note:referred to the Committee of the Whole with favorable recommendation.
This** summary*** applies** to*** this** bill as introduced and does notreflectanyamendmentsthatmaybesubsequentlyadopted.Ifthisbill 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.) g d e 5 The bill repeals the existing nursing facility provider fee and T R 2 A 2 2 Shading denotes HOUSE amendment.
Double underlining denotes SENATE amendment.E d r Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law.
e A intermediatecarefacilityservicefee,effectiveMay1,2025,andprovides 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 policyand 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fee and a new healthcare affordability and sustainability intermediate care facility fee that function similarly to the repealed fees.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 boardwithinCHASEforthepurposeofsupportingtheexistingenterprise withtheimplementationofthehealthcareaffordabilityandsustainability 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 individualswithintellectualdisabilities.BecauseCHASEisanenterprise 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.
Be it enacted by the General Assembly of the State of Colorado:
SECTION1.
InColoradoRevisedStatutes,25.5-4-402.4,amend (2) introductory portion, (2)(a), (2)(c) introductory portion, (2)(c)(V), (2)(c)(VI), (2)(d) introductory portion, (2)(e), (2)(f), (2)(g), (3)(a), (3)(c)(I), (3)(d)(I), (3)(d)(II), (3)(d)(III), (3)(d)(V), (4)(b) introductory portion,(4)(b)(II),(4)(b)(III),(4)(c)(I)introductoryportion,(4)(c)(II)(C), (4)(c)(III)introductoryportion,(4)(c)(III)(E),(4)(c)(III)(F),(4)(e),(4)(f), (5)(a), (5)(b) introductory portion, (5)(b)(IV) introductory portion, -2- 270 (5)(b)(VI)(B), (5)(c)(I)(A), (5)(c)(II)(C), (5)(c)(III), (5)(c)(V), (6)(a)(I), (6)(b)introductoryportion,(6)(b)(II),(6)(b)(III)(A),(6)(b)(III)(B),(6)(c), (7)(b), (7)(d)(I), (7)(d)(II), (7)(d)(III), (7)(d)(IX), (7)(d)(X), (7)(e) introductory portion, (7)(e)(II), (7)(e)(III) introductory portion, and (7)(e)(IV);
amend as they exist until July 1, 2025, (2)(d)(I), (4)(a) introductory portion, and (4)(g);
and add (2)(c)(V.5), (2)(c)(V.7), (2)(d.5), (2)(d.7), (3)(c)(III), (3)(c)(IV), (4.5), (4.7), (5.5), (5.7), (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:
25.5-4-402.4.
Healthcare affordability and sustainability hospital provider fee - healthcare affordability and sustainability nursing facility provider fee - healthcare affordability and sustainability intermediate care facility fee - Colorado healthcare affordability and sustainability enterprise - federal waiver - funds created - reports - rules - legislative declaration - repeal.
(2) Legislative declaration.
The general assembly herebynds and declares that:
(a) The state and the providers of publicly funded medical services,andhospitals,RSINGFACILITYPROVIDERS ,ANDINTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIEin particular, share a common commitment to comprehensive health-care reform;
(c) This section is enacted as part of acomprehensivehealth-care reform and is intended to provide the following services and benefits to hospitals,URSINGFACILITYPROVIDERS ,INTERMEDIATECAREFACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIE, and individuals:
(V) Expanding access to high-quality, affordable health care for -3- 270 low-income and uninsured populations;
and (V.5) S USTAINING OR INCREASING THE REIMBURSEMENT FOR PROVIDING MEDICAL CARE UNDER THE STATE S MEDICAL ASSISTANCE PROGRAMFORNURSINGFACILITYPROVIDERSANDMAKINGSUPPLEMENTAL MEDICAID PAYMENTS TO NURSING FACILITY PROVIDERS;
(V.7) M AINTAINING THE QUALITY AND CONTINUITY OF SERVICES PROVIDED BY INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIE;AND (VI) Providing the additional business services specified in subsection (4)(a)(IV) of this section to hospitals that pay the healthcare affordability and sustainabilityITAL PROVIDER fee charged and collected as authorized by subsection (4) of this section by the Colorado healthcareaffordabilityandsustainabilityenterprisecreatedinsubsection (3)(a) of this section;
(d) The Colorado healthcare affordability and sustainability enterprise provides business services to hospitals when, in exchange for paymentofhealthcareaffordabilityandsustainabilityTALPROVIDER fees by hospitals, it:
(I) Obtains federal matching money and returns both the healthcareaffordabilityandsustainabilityTALPROVIDER feeandthe federal matching money to hospitals to increase reimbursement rates to hospitals for providing medical care under the state medical assistance program and the Colorado indigent care program and to increase the number of individuals covered by public medical assistance;
and (d.5) T HE C OLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY ENTERPRISE PROVIDES BUSINESS SERVICES TO NURSING FACILITY PROVIDERS WHEN ,IN EXCHANGE FOR PAYMENT OF NURSING -4- 270 FACILITY PROVIDER FEE,IT OBTAINS FEDERAL MATCHING MONEY AND RETURNS BOTH THE NURSING FACILITY PROVIDER FEE AND THE FEDERAL MATCHING MONEY TO NURSING FACILITY PROVIDERS TO SUSTAIN OR INCREASE REIMBURSEMENT RATES AND MAKE SUPPLEMENTAL MEDICAID PAYMENTS TO NURSING FACILITY PROVIDER;
(d.7) THE C OLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY ENTERPRISE PROVIDES BUSINESS SERVICES TO INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES WHE,INEXCHANGE FOR PAYMENT OFINTERMEDIATE CARE FACILITY FEE,IT OBTAINS FEDERAL MATCHING MONEY AND RETURNS BOTH THE INTERMEDIATE CARE FACILITY FEE AND THE FEDERAL MATCHING MONEY TO INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES TO SUSTAIN OR INCREASE REIMBURSEMENTRATESANDMAKESUPPLEMENTALMEDICAIDPAYMENTS TO SUCH INTERMEDIATE CARE FACILITI;S (e) It is necessary, appropriate, andinthe best interest of the state to acknowledge that by providing the business services specified in subsections(2)(d)(I)and(2)(d)(II)ECTIONS(2)(d)TO(2)(d.7)ofthis section,theColoradohealthcareaffordabilityandsustainabilityenterprise engages in an activity conducted in the pursuit of a benefit, gain, or livelihood and therefore operates as a business;
(f) Consistent with the determination of the Colorado supreme courtinNichollv.E-470PublicHighwayAuthority,896P.2d859(Colo.
1995),thatthepowertoimposetaxesisinconsistentwithenterprisestatus under section 20 of article X of the state constitution, it is the conclusion ofthegeneralassemblythatthehealthcareaffordabilityandsustainability HOSPITAL PROVIDER fee,THE HEALTHCARE AFFORDABILITY AND -5- 270 SUSTAINABILITYNURSINGFACILITYPROVIDERFEE ,ANDTHEHEALTHCARE AFFORDABILITY AND SUSTAINABILITY INTERMEDIATE CARE FACILITY FEE charged and collected by the Colorado healthcare affordability and sustainability enterprise is a feeEES, not a tTAXES , because the fee isFEES ARE imposed for the specific purposes of allowing the enterprisetodefraythecostsof providingthebusinessservicesspecified in subsections (2)(d)(I) and (2)(d)(II)TIONS (2)(d)TO(2)(d.7) of this section to hospitals, NURSING FACILITY PROVIDERS, AND INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIESthat pay the fFEES and isARE collected at rates that are reasonably calculated based on the benefits received by those hospitals, NURSINGFACILITYPROVIDERS ,ANDINTERMEDIATE CAREFACILITIES ;and (g) So long as the Colorado healthcare affordability and sustainabilityenterprisequalifies as an enterpriseforpurposesof section 20 of article X of the state constitution, the revenues from the healthcare affordability and sustainability fee charged and collected by the enterprise are not state fiscal year spending, as defined in section 24-77-102 (17), or state revenues, as defined in section 24-77-103.6 (6)(c), and do not count against either the state fiscal year spending limit imposed 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).
(3) Colorado healthcare affordability and sustainability enterprise.
(a) The Colorado healthcare affordabilityand sustainability enterprise referred to in this section as the "enterprise",ed.
The enterprise is and operates as a government-owned business within the state department for the purpose of:
(I) Charging and collecting:
-6- 270 (A) The healthcare affordability and sustainabiHOSPITAL PROVIDER fee;
(B) THE NURSING FACILITY PROVIDER FE;AND (C) THE INTERMEDIATE CARE FACILITY FE;
(II) Leveraging healthcare affordability and sustainability REVENUE FROM THE HOSPITAL PROVIDER fee, revenueTHE NURSING FACILITY PROVIDER FEE,AND THE INTERMEDIATE CARE FACILITY FEEto obtain federal matching money;
and (III) Utilizing and deploying:
(A) The healthcare affordability and sustainabilityITAL PROVIDER fee revenue and federal matching money to provide the business services specified in subsections (2)(d)(I) and (2)(d)(II) of this sectiontohospitalsthatpaythehealthcareaffordabilityandsustainability fee;
(B) T HE NURSING FACILITY PROVIDER FEE REVENUE AND ANY FEDERAL MATCHING MONEY TO PROVIDE THE BUSINESS SERVICES SPECIFIED IN SUBSECTIO(2)(d.5OFTHISSECTIONTONURSING FACILITY PROVIDERS THAT PAY THE NURSING FACILITY PROVIDER FE;AND (C) T HE INTERMEDIATE CARE FACILITY FEE REVENUE AND ANY FEDERAL MATCHING MONEY TO PROVIDE THE BUSINESS SERVICES SPECIFIED IN SUBSECTION(2)(d.7)OF THIS SECTION TO INTERMEDIATE CAREFACILITIESFORINDIVIDUALSWITHINTELLECTUALDISABILITIESTHAT PAY THE INTERMEDIATE CARE FACILITY FE.
(c) (I) The repeal of the hospital provider fee program, as it existed pursuant to section 25.5-4-402.3 before its repeal, effective July 1, 2017, by Senate Bill 17-267, enacted in 2017, and the creation of the Colorado healthcare affordability and sustainability enterprise as a new -7- 270 enterprise to charge and collect a new healthcare affordability and sustainabilitySPITAL PROVIDERfee as authorized by subsection (4) of this section and provide healthcare affordability and sustainability fee-funded business services to hospitals that replace and supplement servicespreviouslyfundedbyHEREPEALED hospitalproviderfeesisthe creation of a new government-owned business that provides business services to hospitals as a new enterprise for purposes of section 20 of article X of the state constitution, does not constitute the qualification of an existing government-owned business as an enterprise for purposes of section 20 of article X of the state constitution or section 24-77-103.6 (6)(b)(II), and, therefore, does not require or authorize adjustment of the statefiscalyearspendinglimitcalculatedpursuanttosection20ofarticle X of the state constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I).
(III) THE REPEAL OF THE NURSING FACILITY PROVIDER FEE PROGRAM ,AS IT EXISTED IN SECTI25.5-6-203 (1BEFORE ITS REPEA, EFFECTIVEM AY 1,2025,BYSENATE B ILL25-270ENACTEDIN 2025,AND THEENTERPRISE SABILITYTOCHARGEANDCOLLECTANEWHEALTHCARE AFFORDABILITYANDSUSTAINABILITYNURSINGFACILITYPROVIDERFEEAS AUTHORIZED BY SUBSECTION (4.5)OF THIS SECTION AND PROVIDE FEE-FUNDED BUSINESS SERVICES TO NURSING FACILITY PROVIDERS THAT REPLACE AND SUPPLEMENT SERVICES PREVIOUSLY FUNDED BY THE NURSING FACILITY PROVIDER FEE DOES NOT CONSTITUTE CREATION OF A NEW ENTERPRISE OR THE QUALIFICATION OF AN EXISTING GOVERNMENT -OWNED BUSINESS AS AN ENTERPRISE FOR PURPOSES OF SECTION 20 OF ARTICLE X OF THE STATE CONSTITUTION , SECTION 24-77-103.6 (6)(b)(II),SECTION24-77-108,AND ,THEREFORE ,DOES -8- 270 NOT REQUIRE OR AUTHORIZE ADJUSTMENT OF THE STATE FISCAL YEAR SPENDINGLIMITCALCULATEDPURSUANT TOSECTION 20OFARTICLE X OF THE STATE CONSTITUTION OR THE EXCESS STATE REVENUES CAP ,AS DEFINEDINSECTION 24-77-103.6(6)(b)(ANDDOESNOTREQUIREVOTER APPROVAL .
(IV) THE REPEAL OF THE INTERMEDIATE CARE FACILITY SERVICE FEE PROGRAM ,AS IT EXISTED IN SECT25.5-6-204 (1)(c)BEFORE ITS REPEAL,EFFECTIVE M AY1, 2025,BYS ENATE BILL25-270,ENACTED IN 2025,AND THE ENTERPRISE'S ABILITY TO CHARGE AND COLLECT A NEW HEALTHCAREAFFORDABILITYANDSUSTAINABILITYINTERMEDIATE CARE FACILITY FEE AS AUTHORIZED BY SUBSECTI(4.7)OFTHIS SECTION AND PROVIDE FEE FUNDED BUSINESS SERVICES TO INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES THAT REPLACE AND SUPPLEMENT SERVICES PREVIOUSLY FUNDED BY THE INTERMEDIATE CARE FACILITY SERVICE FEE DOES NOT CONSTITUTE CREATION OF A NEW ENTERPRISE OR THE QUALIFICATION OF AN EXISTING GOVERNMENT -OWNED BUSINESS AS AN ENTERPRISE FOR PURPOSES OF SECTION 20 OF ARTICLE X OF THE STATE CONSTITUTION , SECTION 24-77-103.6 (6)(b)(IOR SECTION24-77-108,AND ,THEREFORE ,DOES NOT REQUIRE OR AUTHORIZE ADJUSTMENT OF THE STATE FISCAL YEAR SPENDINGLIMITCALCULATEDPURSUANT TOSECTION 20OFARTICLE X OF THE STATE CONSTITUTION OR THE EXCESS STATE REVENUES CAP ,AS DEFINEDINSECTION 24-77-103.6(6)(b)(ANDDOESNOTREQUIREVOTER APPROVAL .
(d) The enterprise's primary powers and duties are:
(I) To charge and collect:
(A) The healthcare affordability and sustainabilityTAL -9- 270 PROVIDER fee as specified in subsection (4) of this section;
(B) T HE NURSING FACILITY PROVIDER FEE AS SPECIFIED IN SUBSECTION (4.5)OF THIS SECTIO;AND (C) T HE INTERMEDIATE CARE FACILITY FEE AS SPECIFIED IN SUBSECTION (4.7)OF THIS SECTIO;
(II) To leverage healthcare affordability and sustainability REVENUE FROM THE HOSPITAL PROVIDER fee, revenue collectTHE NURSINGFACILITYPROVIDERFEE ,ANDTHEINTERMEDIATECAREFACILITY FEE to obtain federal matching money, working with or through the state department and the state board to the extent required by federal law or otherwise necessary;
(III) To expend:
(A) healthcareaffordabilityandsustainabilityTALPROVIDER fee revenue, matching federal money, and any other money from the healthcare affordability and sustainabilityAL PROVIDERfee cash fund as specified in subsections (4) and (5) of this section;
(B) N URSING FACILITY PROVIDER FEE REVENUE ,MATCHING FEDERAL MONEY ,AND ANY OTHER MONEY FROM THE NURSING FACILITY PROVIDER FEE CASH FUND AS SPECIFIED IN SUBSECTION (5.5)OF THIS SECTION;
AND (C) I NTERMEDIATE CARE FACILITY FEE REVENUE ,MATCHING FEDERALMONEY ,ANDANYOTHERMONEYFROMTHEINTERMEDIATECARE FACILITY FEE CASH FUND AS SPECIFIED IN SUBSECTION (5.7)OF THIS SECTION;
(V) To enter into agreements with the state department to the extent necessary to collect and expend healthcare affordability and sustainabilityVENUE FROM THE HOSPITAL PROVIDER fee, revenuTHE -10- 270 NURSINGFACILITYPROVIDERFEE ,ANDTHEINTERMEDIATECAREFACILITY FEE ;
(4) Healthcare affordability and sustainability hospital provider fee.
(a) For the fiscal year commencing July 1, 2017, and for each fiscal year thereafter, the enterprise is authorized to charge and collect a healthcare affordability and sustainability PROVIDER fee, as described in 42 CFR 433.68 (b), on outpatient and inpatient services provided by all licensed or certified hospitals referred to in this section as "hospitals",r the purpose of obtaining federal financial participation under the state medical assistance program as described in this article 4 and articles 5 and 6 of this title 25.5 referred to in this section as the "state medical assistance prograand the Colorado indigent care program described in part 1 of article 3 of this title 25.5, referred to in this section as the "Colorado indigent care program".
If the amountofhealthcareaffordabilityandsustainabilitySPITALPROVIDER feerevenue collected exceeds the federal net patient revenue-based limit on the amount 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 shall be responsible for repaying the excess federal money and any associated federal penalties to the federal government.
The enterprise shall use the healthcare affordability and sustainabilityPITAL PROVIDER fee revenue to:
(b) The enterprise shall recommend for approval and establishmentbythestateboardtheamountofthehealthcareaffordability and sustainabilityOSPITAL PROVIDER fee that it intends to charge and collect.Thestateboardmustestablishthefinalamountofthefeebyrules -11- 270 promulgatedinaccordancewitharticle4of title24.Thestateboardshall not establish anyamount that exceedsthe federal limit for such fees.
The state board maydeviate from the recommendations of the enterprise, but shallexpressinwritingthereasonsforanydeviations.Inestablishingthe amount of the fee and in promulgating the rules governing the fee, the state board shall:
(II) Establish the amount of the healthcare affordability and sustainabiliHOSPITAL PROVIDER fee so that the amount collected from the fee and federal matching funds associated with the fee are sufficient to pay for the items described in subsection (4)(a) of this section, but nothing in this subsection (4)(b)(II) requires the state board to increase the fee above the amount recommended by the enterprise;
and (III) For the 2017-18 fiscal year, establish the amount of the healthcareaffordabilityandsustainabilityITALPROVIDER feesothat the amount collected from the fee is approximately equal to the sum of the amounts of the appropriations specified for the fee in the general appropriation act, Senate Bill 17-254, enacted in 2017, and any other supplemental appropriation act.
(c)(I) Inaccordancewiththeredistributivemethodsetforthin42 CFR 433.68 (e)(1) and (e)(2), the enterprise, acting in concert with or throughanagreementwiththestatedepartmentifrequiredbyfederallaw, may seek a waiver from the broad-based healthcare affordability and sustainabilityOSPITAL PROVIDER fee requirement or the uniform healthcare affordability and sustainabilityPITAL PROVIDER fee requirement,orboth.Inaddition,theenterprise,actinginconcertwithor throughanagreementwiththestatedepartmentifrequiredbyfederallaw, shall seek any federal waiver necessary to fund and, in cooperation with -12- 270 the state department and hospitals, support the implementation of a health-care delivery system reform incentive payments program as describedinsubsection(8)ofthissection.Subjecttofederalapprovaland to minimize the financial impact on certain hospitals, the enterprise may exempt from payment of the healthcare affordability and sustainability HOSPITAL PROVIDER fee certain types of hospitals, including but not limited to:
(II) In determining whether a hospital may be excluded, the enterprise shall use one or more of the following criteria:
(C) A hospital whose inclusion or exclusion would not significantly affect the net benefit to hospitals paying the healthcare affordability and sustainabHOSPITAL PROVIDER fee;
or (III) The enterprise may reduce the amount of the healthcare affordability and sustainabilityPITAL PROVIDER fee for certain hospitals to obtain federal approval and to minimize the financial impact oncertainhospitals.Indeterminingforwhichhospitalstheenterprisemay reduce the amount of the healthcare affordability and sustainability HOSPITAL PROVIDER fee, the enterprise shall use one or more of the following criteria:
(E) If the hospital paid a reduced healthcare affordability and sustainabilityOSPITAL PROVIDER fee, the reduced fee would not significantly affect the net benefit to hospitals paying the healthcare affordability and sustainabilityor (F) The hospital is required not to pay a reduced healthcare affordabilityand sustainabilityITAL PROVIDER fee as a condition of federal approval.
(e) (I) The enterprise shall establish policies on the calculation, -13- 270 assessment, and timing of the healthcare affordability and sustainability HOSPITAL PROVIDER fee.
The enterprise shall assess the healthcare affordability and sustainabilityTAL PROVIDER fee on a schedule to be set by the enterprise board as provided in subsection (7)(d) of this section.TheperiodichealthcareaffordabilityandsustainabilityTAL PROVIDER fee payments from a hospital and the enterprise's reimbursement to the hospital under subsections (5)(b)(I) and (5)(b)(II) ofthissectionaredueasnearlysimultaneouslyasfeasible;exceptthatthe enterprise's reimbursement to the hospital is due no more than two days after the periodic healthcare affordability and sustainability PROVIDER fee payment is received from the hospital.
The healthcare affordabilityand sustainabiHOSPITALPROVIDER feemust be imposed on each hospital even if more than one hospital is owned by the same entity.
The fee must be prorated and adjusted for the expected volume of service for any year in which a hospital opens or closes.
(II) The enterprise is authorized to refund any unused portion of thehealthcareaffordabilityandsustainabilityITALPROVIDER fee.For any portion of the healthcare affordability and sustainability PROVIDER fee that has been collected by the enterprise but for which the enterprise has not received federal matching funds, the enterprise shall refund 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.
(III) Theenterpriseshallestablishrequirementsforthereportsthat hospitalsmustsubmittotheenterprisetoallowtheenterprisetocalculate the amount of the healthcare affordability and sustainabilityL PROVIDER fee.
Notwithstanding the provisions of part 2 of article 72 of title 24 or subsection (7)(f) of this section, information provided to the -14- 270 enterprise pursuant to this section is confidential and is not a public record.Nonetheless,theenterprisemayprepareandreleasesummariesof the reports to the public.
(f) A hospital shall not include any amount of the healthcare affordabilityand sustainabilityTALPROVIDER feeas a separate line item in its billing statements.
(g) The state board shall promulgate any rules pursuant to the "State Administrative Procedure Act", article 4 of title 24, necessary for theadministrationandimplementationofthissection.Priortosubmitting any proposed rules concerning the administration or implementation of the healthcare affordabilityand sustainabilityPROVIDER fee to the state board, the enterprise shall consult with the state board on the proposed rules as specified in subsection (7)(d) of this section.
(4.5) Healthcare affordability and sustainability nursing facility provider fee.
(a) BING ON M AY1,2025, THE ENTERPRISE ISAUTHORIZEDTOCHARGEANDCOLLECTAHEALTHCAREAFFORDABILITY ANDSUSTAINABILITYNURSINGFACILITYPROVIDERFEEONHEALTH -CARE ITEMS OR SERVICES PROVIDED BY NURSING FACILITY PROVIDERS FOR THE PURPOSE OF OBTAINING FEDERAL FINANCIAL PARTICIPATION UNDER THE STATE MEDICAL ASSISTANCE PROGRAM AS DESCRIBED IN THIS ARTIC4E AND ARTICLES 5AND 6 OF THIS TITL25.5.
HE ENTERPRISE SHALL USE THE NURSING FACILITY PROVIDER FEE REVENUE TO PROVIDE A BUSINESS SERVICETONURSINGFACILITYPROVIDERSBYSUSTAININGORINCREASING REIMBURSEMENT FOR PROVIDING MEDICAL CARE UNDER THE STATE MEDICAL ASSISTANCE PROGRAM FOR NURSING FACILITY PROVIDERS AND MAKING SUPPLEMENTAL MEDICAID PAYMENTS TO NURSING FACILITY PROVIDERS,AS SPECIFIED BY THE PRIORITY OF THE USES OF THE NURSING -15- 270 FACILITY PROVIDER FEE REVENUE SET FORTH IN SUBSECTI(5.5)(bOF THIS SECTIO.
(b) THE ENTERPRISE SHALL RECOMMEND FOR APPROVAL AND ESTABLISHMENT BY THE STATE BOARD THE AMOUNT OF THE NURSING FACILITY PROVIDER FEE THAT IT INTENDS TO CHARGE AND COLL.THE STATE BOARD MUST ESTABLISH THE FINAL AMOUNT OF THE FEE BY RU.E THE STATE BOARD SHALL NOT ESTABLISH ANY AMOUNT THAT EXCEEDS THE FEDERAL LIMIT FOR SUCH FEES.
HE STATE BOARD MAY DEVIATE FROM THE RECOMMENDATIONS OF THE ENTERPRISE BUT SHALL EXPRESS IN WRITING THE REASONS FOR ANY DEVIATIONS.N ESTABLISHING THE AMOUNT OF THE FEE AND IN PROMULGATING THE RULES GOVERNING THE FEE,THE STATE BOARD SHALL:
(I) CONSIDER RECOMMENDATIONS OF THE ENTERPRISE;AND (II) ETABLISHTHEAMOUNTOFTHENURSINGFACILITYPROVIDER FEE SO THAT THE AMOUNT COLLECTED FROM THE FEE AND FEDERAL MATCHINGFUNDSASSOCIATEDWITHTHEFEEARESUFFICIENTTOPAYFOR THE ITEMS DESCRIBED IN SUBSECTION (4.5)(aOF THIS SECTION,BUT NOTHINGINTHISSUBSECTION (4.5)(b)(REQUIRESTHESTATEBOARDTO INCREASE THE FEE ABOVE THE AMOUNT RECOMMENDED BY THE ENTERPRISE.
(c) TEENTERPRISESHALLNOTCHARGEORCOLLECTTHENURSING FACILITYPROVIDERFEEINTHEABSENCEOFTHEFEDERALGOVERNMENT S APPROVAL OF A STATE MEDICAID PLAN AMENDMENT AUTHORIZING FEDERALFINANCIALPARTICIPATIONFORTHENURSINGFACILITYPROVIDER FEE.
THE ENTERPRISE MAY ALTER THE PROCESS PRESCRIBED IN THIS SUBSECTION (4.5)TO THE EXTENT NECESSARY TO MEET FEDERAL REQUIREMENTS AND TO OBTAIN FEDERAL APPROVAL .
HE ENTERPRISE -16- 270 MAY LOWER THE AMOUNT OF THE NURSING FACILITY PROVIDER FEE CHARGED TO CERTAIN NURSING FACILITY PROVIDERS TO MEET THE REQUIREMENTS OF 42 CFR 433.68 (e) AND TO OBTAIN FEDERAL APPROVAL .
(d) (I) IACCORDANCE WITH THE REDISTRIBUTIVE METHOD SET FORTH IN42 CFR 433.68 (e)(1AND (e)(2)THE ENTERPRISE,ACTING IN CONCERT WITH OR THROUGH AN AGREEMENT WITH THE STATE DEPARTMENT IF REQUIRED BY FEDERAL LAW,MAY SEEK A WAIVER FROM THE BROAD -BASED NURSING FACILITY PROVIDER FEE REQUIREMENT OR THE UNIFORM NURSING FACILITY PROVIDER FEE REQUIREMENOR BOTH .
(II) SUBJECT TO FEDERAL APPROVAL AND TO MINIMIZE THE FINANCIAL IMPACT ON CERTAIN NURSING FACILITY PROVIDERS , THE ENTERPRISE MAY EXEMPT FROM PAYMENT OF THE NURSING FACILITY PROVIDER FEE CERTAIN TYPES OF NURSING PROVIDER FACILITIES , INCLUDING BUT NOT LIMITED T:
(A) A FACILITY OPERATED AS A CONTINUING CARE RETIREMENT COMMUNITY THAT PROVIDES A CONTINUUM OF SERVICES BY ONE OPERATIONAL ENTITY PROVIDING INDEPENDENT LIVING SERVICES , ASSISTED LIVING SERVICE,AND SKILLED NURSING CARE ON A SINGLE, CONTIGUOUS CAMPUS .A SSISTED LIVING SERVICES INCLUDE AN ASSISTED LIVINGRESIDENCEASDEFINEDINSECTION 25-27-102ORAFACILITYTHAT PROVIDES ASSISTED LIVING SERVICES-SITE,TWENTY FOUR HOURS PER DAY ,SEVEN DAYS PER WEEK.
(B) A SKILLED NURSING FACILITY OWNED AND OPERATED BY THE STATE;
(C) A NURSING FACILITY THAT IS A DISTINCT PART OF A FACILITY THAT IS LICENSED AS A GENERAL ACUTE CARE HOSPIT;AND -17- 270 (D) A FACILITY THAT HAS FORTY-FIVE OR FEWER LICENSED BED.
(e) (I) T HE ENTERPRISE SHALL ESTABLISH POLICIES ON THE CALCULATION ,ASSESSMENT , AND TIMING OF THE NURSING FACILITY PROVIDER FEE .
HE ENTERPRISE SHALL ASSESS THE NURSING FACILITY PROVIDER FEE ON A MONTHLY BASIS .
HE NURSING FACILITY PROVIDER FEE PAYMENTS FROM A NURSING FACILITY PROVIDER AND THE ENTERPRISE S REIMBURSEMENT AND SUPPLEMENTAL PAYMENTS TO THE NURSINGFACILITYPROVIDERUNDERSUBSECTION (5.5)(bOFTHISSECTION ARE DUE AS NEARLY SIMULTANEOUSLY AS FEASIBLE ;EXCEPT THAT THE ENTERPRISE S REIMBURSEMENT AND SUPPLEMENTAL PAYMENTS TO THE NURSING FACILITY PROVIDER ARE DUE NO MORE THAN FIFTEEN DAYS AFTERTHENURSINGFACILITYPROVIDERFEEPAYMENTISRECEIVEDFROM THE NURSING FACILITY PROVIDER.
(II) THE ENTERPRISE SHALL ESTABLISH REQUIREMENTS FOR THE REPORTS THAT NURSING FACILITY PROVIDERS MUST SUBMIT TO THE ENTERPRISE TO ALLOW THE ENTERPRISE TO CALCULATE THE AMOUNT OF THE NURSING FACILITY PROVIDER FE,INCLUDING A REQUIREMENT THAT EACHNURSINGFACILITYPROVIDERREPORTANNUALLYITSTOTALNUMBER OF DAYS OF CARE PROVIDED TO NONMEDICARE RESIDENTS .
N OTWITHSTANDING PART 2 OF ARTICLE72 OF TITLE24 OR SUBSECTION (7)(f)OF THIS SECTION,INFORMATION PROVIDED TO THE ENTERPRISE PURSUANT TO THIS SUBSECTION (4.5)(e)(IIS CONFIDENTIAL AND IS NOT A PUBLIC RECORD .
NONETHELESS ,THE ENTERPRISE MAY PREPARE AND RELEASE SUMMARIES OF THE REPORTS TO THE PUBLIC.
(f) A NURSING FACILITY PROVIDER SHALL NOT INCLUDE ANY AMOUNT OF THE NURSING FACILITY PROVIDER FEE AS A SEPARATE LINE ITEM IN ITS BILLING STATEMENT.
-18- 270 (g) (I)HE STATE BOARD SHALL ADOPT ANY RULES PURSUANT TO THE "STATEA DMINISTRATIVEP ROCEDURE ACT "ARTICLE 4OF TITLE24, NECESSARY FOR THE ADMINISTRATION AND IMPLEMENTATION OF THIS SECTION.PRIOR TO SUBMITTING ANY PROPOSED RULES CONCERNING THE ADMINISTRATION OR IMPLEMENTATION OF THE NURSING FACILITY PROVIDER FEE TO THE STATE BOARD,THE ENTERPRISE SHALL CONSULT WITH THE STATE BOARD ON THE PROPOSED RULES AS SPECIFIED IN SUBSECTION (7)(gOF THIS SECTIO.
(4.7) Healthcare affordability and sustainability intermediate care facility fee.
(a) BNING ON M AY 1, 2025THE ENTERPRISE IS AUTHORIZED TO CHARGE AND COLLECT A HEALTHCARE AFFORDABILITY AND SUSTAINABILITY INTERMEDIATE CARE FACILITY FEE ON BOTH PRIVATELYOWNEDANDSTATE -OPERATEDINTERMEDIATECAREFACILITIES FOR INDIVIDUALS WITH INTELLECTUALDISABILITIES FORTHE PURPOSE OF MAINTAINING THE QUALITY AND CONTINUITY OF SERVICES PROVIDED BY INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIE.
THE ENTERPRISE SHALL USE THE INTERMEDIATE CARE FACILITY FEE REVENUE TO PROVIDE A BUSINESS SERVICE TO SUCH INTERMEDIATE CARE FACILITIES BY SUSTAINING OR INCREASING REIMBURSEMENT TO SUCH FACILITIES , AS SPECIFIED IN SUBSECTION (5.7)(b)F THIS SECTIO.
(b) T HE ENTERPRISE SHALL RECOMMEND FOR APPROVAL AND ESTABLISHMENT BY THE STATE BOARD THE AMOUNT OF THE INTERMEDIATE CARE FACILITY FEE THAT IT INTENDS TO CHARGE AND COLLECT ,WHICH MUST NOT EXCEED FIVE PERCENT OF THE TOTAL COSTS INCURRED BY ALL INTERMEDIATE CARE FACILITIES FOR THE FISCAL YEAR IN WHICH THE FEE IS CHARGE.
HE STATE BOARD MUST ESTABLISH THE -19- 270 FINAL AMOUNT OF THE FEE BY RULE .
THE STATE BOARD SHALL NOT ESTABLISH ANY AMOUNT THAT EXCEEDS THE FEDERAL LIMIT FOR SUCH FEES.THESTATEBOARDMAYDEVIATEFROMTHE RECOMMENDATIONSOF THE ENTERPRISE,BUT SHALL EXPRESS IN WRITING THE REASONS FOR ANY DEVIATIONS.
(c) TEENTERPRISEMAYALTERTHEPROCESSPRESCRIBEDINTHIS SUBSECTION (4.7)TO THE EXTENT NECESSARY TO MEET FEDERAL REQUIREMENTS .
(d) (I) THE ENTERPRISE SHALL ESTABLISH POLICIES ON THE CALCULATION ,ASSESSMENT ,AND TIMING OF THE INTERMEDIATE CARE FACILITY FE.
(II) HE ENTERPRISE SHALL ESTABLISH REQUIREMENTS FOR THE REPORTS THAT INTERMEDIATE CARE FACILITIES MUST SUBMIT TO THE ENTERPRISE TO ALLOW THE ENTERPRISE TO CALCULATE THE AMOUNT OF THE INTERMEDIATE CARE FACILITY FE.
NOTWITHSTANDING PART 2 OF ARTICLE 72 OF TITLE 24 OR SUBSECTION (7)(fOF THIS SECTION , INFORMATION PROVIDED TO THE ENTERPRISE PURSUANT TO THIS SUBSECTION (4.7)(d)(IIS CONFIDENTIAL AND IS NOT A PUBLIC REC.RD N ONETHELESS,THEENTERPRISEMAYPREPAREANDRELEASESUMMARIES OF THE REPORTS TO THE PUBL.C (e) TESTATEBOARDSHALLADOPTANYRULESPURSUANTTOTHE "STATE A DMINISTRATIVE PROCEDURE ACT",ARTICLE 4 OF TITLE 24, NECESSARY FOR THE ADMINISTRATION AND IMPLEMENTATION OF THIS SECTION.PRIOR TO SUBMITTING ANY PROPOSED RULES CONCERNING THE ADMINISTRATION OR IMPLEMENTATION OF THE INTERMEDIATE CARE FACILITY FEE TO THE STATE BOARD,THE ENTERPRISE SHALL CONSULT WITH THE STATE BOARD ON THE PROPOSED RULES AS SPECIFIED IN -20- 270 SUBSECTION (7)(gOF THIS SECTIO.
(5) Healthcare affordability and sustainability hospital provider fee cash fund.
(a) (I) Any healthcare affordability and sustainabilitySPITAL PROVIDERfee collected pursuant to this section by the enterprise must be transmitted to the state treasurer, who shall credit the fee to the healthcare affordability and sustainability PROVIDER fee cash fund, which fund is herebycreated.
and referred to in this section as the "fThe state treasurer shall credit all interest and income derived from the deposit and investment of money in the HOSPITAL PROVIDER FEE CASHfund to the fund.
The state treasurer shall investanymoneyinthe HOSPITALPROVIDERFEECASH fundnotexpended forthepurposesspecified in subsection (5)(b) of this sectionasprovided by law.
Money in thHOSPITAL PROVIDER FEE CASH fund shall not be transferred to any other fund and shall not be used for anypurpose other than thepurposesspecified in this subsection (5) and in subsection (4) of this section.
(II) (A) THE FUND CREATED IN THIS SUBSECTION (5)(aWAS RENAMED AS THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITY HOSPITALPROVIDERFEE CASHFUNDIN SENATE B IL25-270,ENACTEDIN 2025.FORPURPOSESOFTHEANNUALGENERALAPPROPRIATIONACTSFOR THE 2024-25 AND 2025-26 STATE FISCAL YEARS, THE CASH FUNDS APPROPRIATIONS MADE TO THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING FROM THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITYFEE CASHFUND ,ASTHE FUND WAS NAMED PRIOR TO THE ENACTMENT OF SENATE BILL25-270,ENACTED IN 2025,ARE FROM THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITY HOSPITAL PROVIDER FEECASHFUND ,ASRENAMEDBY SENATE B IL25-270,ENACTEDIN 2025.
-21- 270 (B) T HIS SUBSECTION(5)(a)(IIIS REPEALED,EFFECTIVEJULY 1, 2027.
(b) Allmoneyinthe HOSPITALPROVIDERFEECASH fundissubject tofederalmatchingasauthorizedunderfederallawand,subjecttoannual appropriation by the general assembly, shall be expended by the enterprise for the following purposes:
(IV) Subjecttoavailablerevenuefromthehealthcareaffordability andsustainabilitHOSPITALPROVIDER feeandfederalmatchingfunds,to expand eligibility for public medical assistance by:
(VI) To pay the enterprise's actual administrative costs of implementingandadministeringthissection,includingbutnotlimitedto the following costs:
(B) The enterprise's actual costs related to implementing and maintaining the healthcare affordability and sustainabilityTAL PROVIDER fee, including personal services, operating, and consulting expenses;
(c) ARPA home- and community-based services account.
(I)(A) Thereiscreatedthe"ARPAhome-andcommunity-basedservices account"withintheHOSPITALPROVIDERFEECASH fund,referredtointhis subsection (5)(c) as the "ARPA account".
Notwithstanding any other provision of this section to the contrary, money in the ARPA account as a result of fund savings and federal matching dollars must be used in accordance with section 9817 of the federal "American Rescue Plan Act of 2021", Pub.L.
117-2, as amended, referred to in this section as "ARPA", to implement or supplement the implementation of home- and community-basedservicesunderthemedicalassistanceprogrampursuant to the provisions of part 18 of article 6 of this title 25.5.
-22- 270 (II) (C) If the fund savings due to the enhanced federal match under ARPA is less than the amount transferred to the ARPA account under subsection (5)(c)(II)(A) of this section, then the state department shall notify the state treasurer of the amount by which the transfer exceeds the savings.
The state treasurer shall transfer this amount from the ARPA account to theOSPITAL PROVIDER FEE CASfund.
(III) Thestatetreasurershallcreditallinterestandincomederived from the money in the ARPA account to tHOSPITAL PROVIDER FEE CASH fund.
(V) Money in the ARPA account remains in the ARPA account until the end of the spending period authorized under ARPA, at which time money remaining in the ARPA account becomes part of the HOSPITAL PROVIDER FEE CASHfund.
(5.5) Healthcare affordability and sustainability nursing facility provider fee cash fund.
(a) AALTHCARE AFFORDABILITY ANDSUSTAINABILITYNURSINGPROVIDERFEESCOLLECTED PURSUANT TO THIS SECTION BY THE ENTERPRISE MUST BE TRANSMITTED TO THE STATE TREASURER , WHO SHALL CREDIT THE FEE TO THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITY NURSING FACILITY PROVIDER FEE CASH FUND ,WHICH FUND IS CREATED .
HE STATE TREASURER SHALL CREDIT ALL INTEREST AND INCOME DERIVED FROM THE DEPOSIT AND INVESTMENT OF MONEY IN THE NURSING FACILITY PROVIDER FEE CASH FUND TO THE NURSING FACILITY PROVIDER FEE CASH FUN.
HE STATE TREASURER SHALL INVEST ANY MONEY IN THE NURSING FACILITY PROVIDERFEECASHFUNDNOTEXPENDEDFORTHEPURPOSESSPECIFIEDIN SUBSECTIONS (4.5)(AND (5.5)(bOFTHISSECTIONASPROVIDEDBYLAW .
M ONEY IN THE NURSING FACILITY PROVIDER FEE CASH FUND SHALL NOT -23- 270 BE TRANSFERRED TO ANY OTHER FUND AND SHALL NOT BE USED FOR ANY PURPOSEOTHERTHANTHE PURPOSESSPECIFIEDINTHISSUBSECTION (5.5) AND IN SUBSECTION(4.5)(aOF THIS SECTIO.
(b) ALL MONEY IN THE NURSING FACILITY PROVIDER FEE CASH FUNDISSUBJECTTOFEDERALMATCHINGASAUTHORIZEDUNDERFEDERAL LAW AND ,SUBJECT TO ANNUAL APPROPRIATION BY THE GENERAL ASSEMBLY ,MUST BE EXPENDED BY THE ENTERPRISE FOR THE FOLLOWING PURPOSES:
(I) (A) T PAY THE ADMINISTRATIVE COSTS OF IMPLEMENTING THIS SUBSECTION(5.5AND SUBSECTION (4.5)OF THIS SECTI;N (B) TO SATISFY SETTLEMENTS OR JUDGMENTS RESULTING FROM NURSING FACILITY PROVIDER REIMBURSEMENT APPEALS;AND (C) T O PAY A NURSING FACILITY PROVIDER A SUPPLEMENTAL MEDICAID PAYMENT FOR CARE AND SERVICES RENDERED TO MEDICAID RESIDENTSTOOFFSETPAYMENTOFTHENURSINGFACILITYPROVIDERFEE .
THEENTERPRISE INCONSULTATIONWITHTHESTATEDEPARTMENT ,SHALL COMPUTE THIS PAYMENT ANNUALLY ,BEGINNING ONM AY 1, 2025,AND EACH JULY 1THEREAFTER .
(II) A FTER THE PAYMENT OF THE AMOUNTS DESCRIBED IN SUBSECTION (5.5)(b)(IOF THIS SECTIO,TO PAY THE SUPPLEMENTAL MEDICAID PAYMENTS FOR ACUITY OR CASE -MIX OF RESIDENTS ESTABLISHED UNDER SECTION 25.5-6-202 (2PRIOR TO ITS REPEAL ON JULY 1, 2026,OR AS PROVIDED IN THE RULES ADOPTED BY THE STATE BOARD PURSUANT TO SECTION 25.5-6-202 (10)AND (14)(a)IN CONSULTATION WITH THE ENTERPRISE AS PROVIDED IN SUBSECTION (7)(g)(IV)F THIS SECTIO;
(III) AFTER THE PAYMENT OF THE AMOUNTS DESCRIBED IN -24- 270 SUBSECTIONS (5.5)(b)(IAND (5.5)(b)(IOF THIS SECTION, TO PAY SUPPLEMENTAL MEDICAID PAYMENTS BASED UPON PERFORMANCE TO THOSE NURSING FACILITY PROVIDERS THAT PROVIDE SERVICES THAT RESULT IN BETTER CARE AND HIGHER QUALITY OF LIFE FOR THEIR RESIDENTS.T HE ENTERPRIS,IN CONSULTATION WITHTHE STATE BOARD , SHALL DETERMINE THE PAYMENT AMOUNT BASED UPON PERFORMANCE MEASURES ESTABLISHED IN RULES ADOPTED BYTHE STATE BOARD IN THE DOMAINS OF QUALITY OF LIFE ,QUALITY OF CARE , AND FACILITY MANAGEMENT .DURING EACH STATE FISCAL YEA,THE ENTERPRISE MAY DISCONTINUE THE SUPPLEMENTAL MEDICAID PAYMENT ESTABLISHED PURSUANT TO THIS SUBSECTION (5.5)(b)(IITO ANY NURSING FACILITY PROVIDERTHATFAILSTOCOMPLYWITHTHEESTABLISHEDPERFORMANCE MEASURES DURING THE STATE FISCAL YEAR ,AND THE ENTERPRISE MAY INITIATETHESUPPLEMENTALMEDICAIDPAYMENTESTABLISHEDPURSUANT TO THIS SUBSECTION (5.5)(b)(IITO ANY NURSING FACILITY PROVIDER THAT COMES INTO COMPLIANCE WITH THE ESTABLISHED PERFORMANCE MEASURES DURING THE STATE FISCAL YEAR.
(IV) (A) AFTER THE PAYMENT OF THE AMOUNTS DESCRIBED IN SUBSECTIONS (5.5)(b)(ITO (5.5)(b)(IIOF THIS SECTIO,TO PAY THE SUPPLEMENTAL MEDICAID PAYMENTS TO NURSING FACILITY PROVIDERS THAT SERVE RESIDENTS WHO HAVE MODERATE TO VERY SEVERE MENTAL HEALTHCONDITIONS DEMENTIADISEASESANDRELATEDDISABILITIES ,OR ACQUIRED BRAIN INJURY.
THE ENTERPRIS,IN CONSULTATION WITH THE STATE DEPARTMENT ,SHALL COMPUTE THIS PAYMENT ANNUALLY , BEGINNING ON M AY 1, 2025AND EACH JULY 1 THEREAFTER.
(B) IFTHE ENTERPRISE DETERMINES,IN CONSULTATION WITH THE STATEDEPARTMENT ,THATTHECASE -MIXREIMBURSEMENTDESCRIBEDIN -25- 270 SUBSECTION (5.5)(b)(IOF THIS SECTION INCLUDES A FACTOR FOR NURSING FACILITY PROVIDERS THAT SERVE RESIDENTS WITH SEVERE DEMENTIA DISEASES AND RELATED DISABILITIES OR ACQUIRED BRAIN INJURY,THE ENTERPRISE MAY ELIMINATE THIS SUPPLEMENTALMEDICAID PAYMENTTOTHOSENURSINGFACILITYPROVIDERSTHATSERVERESIDENTS WITH SEVERE DEMENTIA DISEASES AND RELATED DISABILITIES OR ACQUIRED BRAIN INJURY.
(V) A FTER THE PAYMENT OF THE AMOUNTS DESCRIBED IN SUBSECTIONS (5.5)(b)(TO (5.5)(b)(IVOF THIS SECTIO,TO PAY THE SUPPLEMENTAL MEDICAID PAYMENTS FOR THE AMOUNT OF THE AGGREGATE STATEWIDE AVERAGE PER DIEM RATE OF PATIENT PAYMENT ESTABLISHED UNDER SECTION 25.5-6-202 (9PRIOR TO ITS REPEAL ON JULY 1, 2026,OR AS PROVIDED IN THE RULES ADOPTED BY THE STATE BOARD PURSUANT TO SECTION 25.5-6-202 (10)AND (14)(a),IN CONSULTATION WITH THE ENTERPRISE AS PROVIDED IN SUBSECTION (7)(g)(IV)F THIS SECTIO.
(5.7) Healthcare affordability and sustainability intermediate care facility fee cash fund.
(a) AALTHCARE AFFORDABILITY AND SUSTAINABILITY INTERMEDIATE CARE FACILITY FEES COLLECTED PURSUANT TO THIS SECTION BY THE ENTERPRISE MUST BE TRANSMITTED TO THE STATE TREASURER , WHO SHALL CREDIT THE FEE TO THE HEALTHCAREAFFORDABILITYANDSUSTAINABILITYINTERMEDIATE CARE FACILITY FEE CASH FUND , WHICH FUND IS CREATED .
THE STATE TREASURERSHALLCREDITALLINTERESTANDINCOMEDERIVEDFROMTHE DEPOSIT AND INVESTMENT OF MONEY IN THE INTERMEDIATE CARE FACILITY FEE CASH FUND TO THE INTERMEDIATE CARE FACILITY CASH FUND .
THE STATE TREASURER SHALL INVEST ANY MONEY IN THE -26- 270 INTERMEDIATE CARE FACILITY FEE CASH FUND NOT EXPENDED FOR THE PURPOSES SPECIFIED IN SUBSECTIONS (4.7)(a)AND (5.7)(b)OF THIS SECTION AS PROVIDED BY LAW .
M ONEY IN THE INTERMEDIATE CARE FACILITY FEE CASH FUND SHALL NOT BE TRANSFERRED TO ANY OTHER FUND AND SHALL NOT BE USED FOR ANY PURPOSE OTHER THAN THE PURPOSESSPECIFIEDINTHISSUBSECTION (5.7ANDINSUBSECTION (4.7)(a) OF THIS SECTIO.
(b) ALL MONEY IN THE INTERMEDIATE CARE FACILITY FEE CASH FUNDISSUBJECTTOFEDERALMATCHINGASAUTHORIZEDUNDERFEDERAL LAW AND , SUBJECT TO ANNUAL APPROPRIATION BY THE GENERAL ASSEMBLY ,MUST BE EXPENDED BY THE ENTERPRISE FOR THE FOLLOWING PURPOSES :
(I) TO PAY THE ADMINISTRATIVE COSTS OF IMPLEMENTING THIS SUBSECTION (5.7)AND SUBSECTION(4.7)OF THIS SECTIO;AND (II) T SUPPLEMENT REIMBURSEMENTS TO INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES AS PROVIDED IN SECTION 25.5-6-204.HE ENTERPRISE,IN CONSULTATION WITH THE STATE DEPARTMENT , SHALL COMPUTE THIS PAYMENT ANNUALLY BEGINNING ON M AY 1,2025,ANDEACH JULY 1 THEREAFTER.
(6) Appropriations.
(a) (I) Except as otherwise provided in subsection (6)(b)(I.5) or (6)(b)(I.7) of this section, the healthcare affordabilityandsustainabilityITALPROVIDER feeistosupplement, not supplant, general fund appropriations to support hospital reimbursements.Generalfundappropriationsforhospitalreimbursements shall be maintained at the level of appropriations in the medical services premium line item made for the fiscal year commencing July 1, 2008;
exceptthatgeneralfundappropriationsforhospitalreimbursementsmay -27- 270 be reduced if an index of appropriations to other providers shows that general fund appropriations are reduced for other providers.
If the index shows that general fund appropriations are reduced for other providers, the general fund appropriations for hospital reimbursements shall not be reduced bya greater percentage thanthereductionsof appropriations for the other providers as shown by the index.
(IV) EXCEPTASOTHERWISEPROVIDEDINSUBSECTION (5.5)(b)(V) OFTHISSECTION ,THENURSINGFACILITYPROVIDERFEEISTOSUPPLEMENT , NOT SUPPLANT ,GENERAL FUND APPROPRIATIONS TO SUPPORT NURSING FACILITY PROVIDER REIMBURSEMENTS .
(V) E XCEPT AS OTHERWISE PROVIDED IN SUBSECTION(5.7)(b)(II) OF THIS SECTION , THE INTERMEDIATE CARE FACILITY FEE IS TO SUPPLEMENT , NOT SUPPLANT , GENERAL FUND APPROPRIATIONS TO SUPPORT INTERMEDIATE CARE FACILITY REIMBURSEMENTS .
(b) If the revenue from the healthcare affordability and sustainabilitySPITAL PROVIDER fee is insufficient to fully fund all of the purposes described in subsection (5)(b) of this section:
(II) The hospital provider reimbursement and quality incentive payment increases described in subsections (5)(b)(I) to (5)(b)(III) of this section and the costs described in subsection (5)(b)(VI) of this section shall be fullyfunded using revenue fromthe healthcare affordabilityand sustainabilitySPITALPROVIDER fee and federalmatchingfundsbefore any eligibility expansion is funded;
and (III)(A) Ifthestateboardpromulgatesrulesthatexpandeligibility for medical assistance to be paid for pursuant to subsection (5)(b)(IV) of this section, and the state department thereafter notifies the enterprise board that the revenue available from the healthcare affordability and -28- 270 sustainabiliHOSPITALPROVIDER feeandthefederalmatchingfundswill not be sufficient to pay for all or part of the expanded eligibility, the enterpriseboardshallrecommendtothestateboardreductionsinmedical benefits or eligibility so that the revenue will be sufficient to pay for all of the reduced benefits or eligibility.
After receiving the recommendationsoftheenterpriseboard,thestateboardshalladoptrules providing for reduced benefits or reduced eligibility for which the revenuewillbesufficientandshallforwardanyadoptedrulestothejoint budget committee.
Notwithstanding the provisions of section 24-4-103 (8) and (12), following the adoption of rules pursuant to this subsection (6)(b)(III)(A), the state board shall not submit the rules to the attorney generalandshallnotfiletheruleswiththesecretaryofstateuntilthejoint budgetcommitteeapprovestherulespursuanttosubsection(6)(b)(III)(B) of this section.
(B) Thejointbudgetcommitteeshallpromptlyconsideranyrules adopted by the state board pursuant to subsection (6)(b)(III)(A) of this section.
The joint budget committee shall promptly notify the state department, the state board, and the enterprise board of anyaction on the rules.
If the joint budget committee does not approve the rules, the joint budget committee shall recommend a reduction in benefits or eligibility so that the revenue from the healthcare affordability and sustainability HOSPITALPROVIDER feeandthematchingfederalfundswillbesufficient to pay for the reduced benefits or eligibility.
After approving the rules pursuanttothissubsection(6)(b)(III)(B),thejointbudgetcommitteeshall request that the committee on legal services, created pursuant to section 2-3-501, extend the rules as provided for in section 24-4-103 (8) unless the committee on legal services finds after review that the rules do not -29- 270 conform with section 24-4-103 (8)(a).
(b.5) ITHEREVENUEFROMTHENURSINGFACILITYPROVIDERFEE IS INSUFFICIENT TO FULLY FUND ALL OF THE PURPOSES DESCRIBED IN SUBSECTION (5.5)(bOF THIS SECTIO:
(I) THE GENERAL ASSEMBLY IS NOT OBLIGATED TO APPROPRIATE GENERAL FUND REVENUES TO FUND SUCH PURPOSES ;AND (II) SUBJECT TO THE PRIORITY OF THE USES FOR THE NURSING FACILITY PROVIDER FEE AS PROVIDED IN SUBSECTION (5.5)(b)OF THIS SECTION , THE ENTERPRISE , IN CONSULTATION WITH THE STATE DEPARTMENT ,MAY SUSPEND OR REDUCE ANY SUPPLEMENTAL MEDICAID PAYMENT .
(c) Notwithstanding any other provision of this section, if, after receipt of authorization to receive federal matching funds for money in theHOSPITALPROVIDERFEECASH fund,theauthorizationiswithdrawnor changed so that federal matching funds are no longer available, the enterprise shall cease collecting the healthcare affordability and sustainabilitySPITALPROVIDER feeandshallrepaytothehospitalsany money received by theHOSPITAL PROVIDER FEE CASH fund that is not subject to federal matching funds.
(c.5) NOTWITHSTANDINGANYOTHERPROVISIONOFTHISSECTION , IF,AFTER RECEIPT OF AUTHORIZATION TO RECEIVE FEDERAL MATCHING FUNDS FOR MONEY IN THE NURSING FACILITY PROVIDER FEE CASH FUND, THE AUTHORIZATION IS WITHDRAWN OR CHANGED SO THAT FEDERAL MATCHING FUNDS ARE NO LONGER AVAILABLE ,THE ENTERPRISE SHALL CEASE COLLECTING THE NURSING FACILITY PROVIDER FEE AND SHALL REPAY TO THE NURSING FACILITY PROVIDERS ANY MONEY RECEIVED IN THENURSINGFACILITYPROVIDERFEECASHFUNDTHATISNOTSUBJECTTO -30- 270 FEDERAL MATCHING FUNDS .
(c.7) NOTWITHSTANDINGANYOTHERPROVISIONOFTHISSECTION , IF,AFTER RECEIPT OF AUTHORIZATION TO RECEIVE FEDERAL MATCHING FUNDSFORMONEYINTHE INTERMEDIATE CARE FACILITYFEE CASHFUND , THE AUTHORIZATION IS WITHDRAWN OR CHANGED SO THAT FEDERAL MATCHING FUNDS ARE NO LONGER AVAILABLE ,THE ENTERPRISE SHALL CEASE COLLECTING THE INTERMEDIATE CARE FACILITY FEE AND SHALL REPAY TO THE INTERMEDIATE CARE FACILITIES ANY MONEY RECEIVED IN THE INTERMEDIATE CARE FACILITY FEE CASH FUND THAT IS NOT SUBJECT TO FEDERAL MATCHING FUNDS .
(7) Colorado healthcare affordability and sustainability enterprise board.
(b) Members of the enterprise board serve without compensation but must be reimbursed from money in the HOSPITAL PROVIDER FEE CASH fund for actual and necessary expenses incurred in the performance of their duties pursuant to this section.
(d) The enterprise board has, at a minimum, the following duties:
(I) To determine the timing and method by which the enterprise assesses the healthcare affordability and sustainabilitySPITAL PROVIDER fee and the amount of the fee;
(II) If requested by the health and human services committee of the senate or the publiclth care and human services committee of the houseofrepresentatives,oranysuccessorcommittees,toconsultwiththe committeesonanylegislationthatmayimpactthehealthcareaffordability and sustainability feeEES, PAYMENTS , or hospital reimbursements established pursuant to this section;
(III) To determine changes in the healthcare affordability and sustainabilityOSPITAL PROVIDER fee that increase the number of -31- 270 hospitals benefitting from the uses of the healthcare affordability and sustainabilitye described in subsections (5)(b)(I) to (5)(b)(IV) of this section or that minimize the number of hospitals that suffer losses as a result of paying the healthcare affordability and sustainability PROVIDER fee;
(IX) To monitor the impact of the healthcare affordability and sustainabilitySPITAL PROVIDER fee,THE NURSING FACILITY PROVIDER FEE, AND THE INTERMEDIATE CARE FACILITY FEE on the broader health-care marketplace;
(X) To establish requirements for the reports that hospitals must submit to the enterprise to allowtheenterprisetocalculatethe amount of the healthcare affordability and sustainabilityAL PROVIDER fee;
and (e) On or before January 15, 2018, and on or before 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 public healthcarendhumanservicescommitteeofthehouseofrepresentatives, or any successor committees, the joint budget committee of the general assembly, the governor, and the state board.
The report shall include, but need not be limited to:
(II) A description of the formula for how the healthcare affordabilityand sustainabilityITALPROVIDER fee is calculated and the process bywhich the healthcareaffordabilityandsustainability assessed and collected;
(II.5) ADESCRIPTION OF THE FORMULA FOR HOW THE NURSING FACILITYPROVIDERFEE ISCALCULATED ANDTHE PROCESSBYWHICHTHE FEE IS ASSESSED AND COLLECTED;
-32- 270 (II.7) A DESCRIPTION OF THE FORMULA FOR HOW THE INTERMEDIATE CARE FACILITY FEE IS CALCULATED AND THE PROCESS BY WHICH THE FEE IS ASSESSED AND COLLECTE;
(III) An itemization of the total amount of the healthcare affordability and sustainabilityITAL PROVIDER fee paid by each hospital and any projected revenue that each hospital is expected to receive due to:
(III.5) A ITEMIZATION OF THE TOTAL AMOUNT OF THE NURSING FACILITY PROVIDER FEE PAID BY EACH NURSING FACILITY PROVIDER AND ANY PROJECTED REVENUE THAT EACH NURSING FACILITY PROVIDER IS EXPECTED TO RECEIVE DUE TO INCREASED REIMBURSEMENTS AND SUPPLEMENTAL PAYMENTS MADE PURSUANT TO SUBSECTION (5.5)(bOF THIS SECTION;
(III.7) A N ITEMIZATION OF THE TOTAL AMOUNT OF THE INTERMEDIATE CARE FACILITY FEE PAID BY EACH INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES AND ANY PROJECTED REVENUE THAT EACH INTERMEDIATE CARE FACILITY IS EXPECTED TO RECEIVE DUE TO INCREASED REIMBURSEMENTS MADE PURSUANT TO SUBSECTION (5.7)(bOF THIS SECTIO;
(IV) An itemization of the costs incurred by the enterprise in implementing and administering the healthcare affordability and sustainabilitySPITAL PROVIDERfee,THE NURSING FACILITY PROVIDER FEE,AND THE INTERMEDIATE CARE FACILITY FE;
(g) (I) TE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD ISCREATEDWITHINTHEENTERPRISEFORTHEPURPOSEOFSUPPORTINGTHE ENTERPRISEBOARDWITHTHEIMPLEMENTATIONOFTHENURSINGFACILITY PROVIDERFEE ANDTHE INTERMEDIATECAREFACILITYFEE .THEFACILITY -33- 270 PROVIDERFEEENTERPRISESUPPORTBOARDCONSISTSOFEIGHTMEMBERS APPOINTED BY THE GOVERNOR ,WITH THE ADVICE AND CONSENT OF THE SENATE ,AS FOLLOWS:
(A) T WO MEMBERS WHO ARE REPRESENTATIVES OF NURSING FACILITY ASSOCIATION;
(B) T WO MEMBERS WHO ARE REPRESENTATIVES OF NURSING FACILITIE, WITH ONE MEMBER REPRESENTING A RURAL NURSING FACILITY;
(C) O NE MEMBER WHO IS A RESIDENT OF A LONG -TERM CARE FACILITY OR A CONSUMER OF LONG-TERM CARE SERVICES,OR A FAMILY MEMBER OR GUARDIAN REPRESENTING SUCH RESIDENT OR CONSUMER ;
(D) O NE EMPLOYEE OF THE STATE DEPARTMENT;
(E) O NE EMPLOYEE OF THE DEPARTMENT OF HUMAN SERVICES CREATED IN SECTION24-1-120;AND (F) ONE EMPLOYEE OF THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT CREATED IN SECTION 25-1-102.
(II) (A) MEMBERS OF THE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD SERVE AT THE PLEASURE OFTHE GOVERNOR.A LLTERMS ARE FOR FOUR YEARS.A MEMBER WHO IS APPOINTED TO FILL A VACANCY SHALL SERVE THE REMAINDER OF THE UNEXPIRED TERM OF THE FORMER MEMBER .
(B) THE GOVERNOR SHALL MAKE THE INITIAL APPOINTMENTS TO THE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD AS SOON AS PRACTICAL FOLLOWING M AY 1, 2025.
(III) TE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD SHALL ELECT A CHAIR AND A VICCHAIR FROM AMONG ITS MEMBERS .
(IV) THE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD -34- 270 SHALLFULFILL,ATAMINIMUM THEFOLLOWINGDUTIESONBEHALFOFTHE ENTERPRISE:
(A) T O DETERMINE THE TIMING AND METHOD BY WHICH THE ENTERPRISE ASSESSES THE NURSING FACILITY PROVIDER FEE AND THE INTERMEDIATE CARE FACILITY FEE AND THE AMOUNTS OF THE FE;S (B) TODETERMINECHANGESINTHENURSINGFACILITYPROVIDER FEE THAT INCREASE THE NUMBER OF NURSING FACILITY PROVIDERS BENEFITTING FROM THE USES OF THE FEE DESCRIBED IN SUBSECTION (5.5)(b)F THIS SECTION OR THAT MINIMIZE THE NUMBER OF NURSING FACILITY PROVIDERS THAT SUFFER LOSSES AS A RESULT OF PAYING THE NURSING FACILITY PROVIDER FE;
(C) TODETERMINECHANGESINTHEINTERMEDIATECAREFACILITY FEE THAT INCREASE THE NUMBEROFINTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES THAT BENEFIT FROM THE USES OF THE FEE DESCRIBED IN SUBSECTI(5.7)(bOF THIS SECTION OR THAT MINIMIZE THE NUMBER OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES THAT SUFFER LOSSES AS A RESULT OF PAYING THE NURSING FACILITY PROVIDER ;EE (D) T O CONSULT WITH THE STATE BOARD ON THE RULES REGARDINGPAYMENTSTONURSINGFACILITYPROVIDERSTHATITADOPTS PURSUANT TO SECTION 25.5-6-202 (1AND (14)(a);
(E) TO CONSULT WITH THE STATE BOARD AND THE STATE DEPARTMENT ON THE RULES ,PRICE SCHEDULES ,AND ALLOWANCES REGARDING REIMBURSEMENT AND PAYMENTS TO INTERMEDIATE CARE FACILITIES THAT THEY ADOPT PURSUANT TO SECTIO25.5-6-204;
(F) TO ESTABLISH REQUIREMENTS FOR THE REPORTS THAT NURSING FACILITY PROVIDERS MUST SUBMIT TO THE ENTERPRISE TO -35- 270 ALLOW THE ENTERPRISE TO CALCULATE THE AMOUNT OF THE NURSING FACILITY PROVIDER FE;AND (G) TO ESTABLISH REQUIREMENTS FOR THE REPORTS THAT INTERMEDIATE CARE FACILITIES MUST SUBMIT TO THE ENTERPRISE TO ALLOW THE ENTERPRISE TO CALCULATE THE AMOUNT OF THE INTERMEDIATE CARE FACILITY FEE.
(V) MEMBERS OF THE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD SERVE WITHOUT COMPENSATION BUT MUST BE REIMBURSEDFROMMONEYINTHENURSINGFACILITYPROVIDERFEECASH FUND OR THE INTERMEDIATE CARE FACILITY FEE CASH FUND FOR ACTUAL AND NECESSARY EXPENSES INCURRED IN THE PERFORMANCE OF THEIR DUTIES PURSUANT TO THIS SECTIO.
(9) Definitions.
AUSED IN THIS SECTI,UNLESS THE CONTEXT OTHERWISE REQUIRES :
(a) "CASE-MIX"HASTHESAMEMEANINGASSETFORTHINSECTION 25.5-6-201(8).
(b) "CASE-MIXREIMBURSEMENT "HASTHESAMEMEANINGASSET FORTH IN SECTION25.5-6-201 (12).
(c) "COLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY ENTERPRISE"OR "ENTERPRISE"MEANS THE ENTERPRISE CREATED IN SUBSECTION (3)OF THIS SECTIO.
(d) "FCILITYPROVIDERFEEENTERPRISESUPPORTBOARD " MEANS THE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD CREATED IN SUBSECTION (7)(g)OF THIS SECTIO.
(e) "HEALTHCAREAFFORDABILITYANDSUSTAINABILITYHOSPITAL PROVIDER FEE" OR "HOSPITAL PROVIDER FE" MEANS THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITY HOSPITALPROVIDER FEE CHARGED -36- 270 AND COLLECTED AS AUTHORIZED BY SUBSECTION (4)OF THIS SECTIO.
(f) "HALTHCAREAFFORDABILITYANDSUSTAINABILITYHOSPITAL PROVIDER FEE CASH FUND " OR "HOSPITAL PROVIDER FEE CASH FUND " MEANSTHEHEALTHCAREAFFORDABILITYANDSUSTAINABILITYHOSPITAL PROVIDER FEE CASH FUND CREATED IN SUBSECTION(5)OF THIS SECTIO.
(g) "H EALTHCARE AFFORDABILITY AND SUSTAINABILITY INTERMEDIATE CARE FACILITY FEE" OR INTERMEDIATE CARE FACILITY FEE" MEANS THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITY INTERMEDIATE CARE FACILITY FEE FOR INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES CHARGED AND COLLECTED AS AUTHORIZED BY SUBSECTION (4.7)OF THIS SECTIO.
(h) "H EALTHCARE AFFORDABILITY AND SUSTAINABILITY INTERMEDIATE CARE FACILITY FEE CASH FUN"OR "INTERMEDIATE CARE FACILITYFEE CASHFUND "MEANS THE HEALTHCARE AFFORDABILITYAND SUSTAINABILITYINTERMEDIATE CARE FACILITYFEECASHFUNDCREATED IN SUBSECTION(5.7)OF THIS SECTIO.
(i) "HEALTHCAREAFFORDABILITYANDSUSTAINABILITYNURSING FACILITY PROVIDER FEE"OR "NURSING FACILITY PROVIDER FE" MEANS THEHEALTHCAREAFFORDABILITYANDSUSTAINABILITYNURSINGFACILITY PROVIDERFEECHARGEDANDCOLLECTEDASAUTHORIZEDBYSUBSECTION (4.5)OF THIS SECTIO.
(j) "HEALTHCARE AFFORDABILITYANDSUSTAINABILITYNURSING FACILITYPROVIDERFEECASHFUND "OR"NURSINGFACILITYPROVIDERFEE CASH FUND " MEANS THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITYNURSINGFACILITYPROVIDERFEECASHFUNDCREATEDIN SUBSECTION (5.5)OF THIS SECTIO.
(k) "HOSPITAL"MEANS A LICENSED OR CERTIFIED HOSPITA.
-37- 270 (l) "NURSINGFACILITYPROVIDER "HASTHESAMEMEANINGASSET FORTH IN SECTION25.5-6-201 (25).
(m) "STATE MEDICAL ASSISTANCE PROGRAM " MEANS THE PROGRAM DESCRIBED IN THIS ARTICLE 4AND ARTICLES 5 AND 6 OF THIS TITLE 25.5.
(n) "STATEWIDE AVERAGE PER DIEM RATE " HAS THE SAME MEANING AS SET FORTH IN SECTION25.5-6-201 (35).
(o) "SUPPLEMENTALMEDICAIDPAYMENT "HASTHESAMEMEANING AS SET FORTH IN SECTION25.5-6-201 (36).
SECTION2.
InColoradoRevisedStatutes,25.5-4-402.4,amend (2) introductory portion and (2)(d) introductory portion;
and amend as they will become effective July 1, 2025, (2)(d)(I), (4)(a) introductory portion, and (4)(g)(I) as follows:
25.5-4-402.4.
Healthcare affordability and sustainability hospital provider fee - healthcare affordability and sustainability nursing facility provider fee - healthcare affordability and sustainability intermediate care facility fee - Colorado healthcare affordability and sustainability enterprise - federal waiver - funds created - reports - rules - legislative declaration - repeal.
(2) Legislative declaration.
The general assembly herebynds and declares that:
(d) The Colorado healthcare affordability and sustainability enterprise provides business services to hospitals when, in exchange for paymentofhealthcareaffordabilityandsustainabilityITALPROVIDER fees by hospitals, it:
(I) Obtains federal matching money and returns both the healthcareaffordabilityandsustainabilityITALPROVIDER feeandthe -38- 270 federal matching money to hospitals to increase reimbursement rates to hospitals for providing medical care under the state medical assistance program,includingdisproportionatesharehospitalpaymentspursuantto 42U.S.C.sec.1396r-4,andtoincreasethenumberofindividualscovered by public medical assistance;
and (4) Healthcare affordability and sustainability fee.(a) For the fiscal year commencing July 1, 2017, and for each fiscal year thereafter, theenterpriseisauthorizedtochargeandcollectahealthcareaffordability andsustainabilitySPITALPROVIDER fee,asdescribedin42CFR433.68 (b), on outpatient and inpatient services provided by all licensed or certifiedhospitalsreferredtointhissectionas"hospitals",epurpose of obtaining federal financial participation under the state medical assistance program as described in this article 4 and articles 5 and 6 of this title 25.5, referred to in this section as the "state medical assistance program",including disproportionate share hospital payments pursuant to 42 U.S.C.
sec.
1396r-4.
If the amount of healthcare affordability and sustainabilitySPITAL PROVIDER fee revenue collected exceeds the federalnetpatientrevenue-basedlimitontheamountofsuchfeerevenue 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.
The enterprise shall use the healthcare affordability and sustainabilitySPITAL PROVIDER fee revenue to:
(g) (I) The state board shall promulgate any rules pursuant to the "State Administrative Procedure Act", article 4 of title 24, necessary for theadministrationandimplementationofthissection.Priortosubmitting -39- 270 any proposed rules concerning the administration or implementation of the healthcare affordabilityand sustainabilityALPROVIDER fee to the state board, the enterprise shall consult with the state board on the proposed rules as specified in subsection (7)(d) of this section.
SECTION 3.
In Colorado Revised Statutes, 25.5-5-103, amend (1)(b) as follows:
25.5-5-103.
Mandated programs with special state provisions - rules.
(1) This section specifies programs developed by Colorado to meet federal mandates.
These programs include but are not limited to:
(b) Specialprovisionsrelatingtonursingfacilities,asspecifiedin sections25.5-6-201to25.5-6-203,25.5-6-205,and25.5-6-206SECTIONS 25.5-4-402.4(4.5)AND (5.5), 25.5-6-201, 25.5-6-202, 25.5-6-2AND 25.5-6-206;
SECTION 4.
In Colorado Revised Statutes, 25.5-6-202, amend (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:
25.5-6-202.
Providers - nursing facility provider reimbursement - exemption - rules - repeal.
(5) Subject to available appropriations and the priority of the uses of the provider fees as establishedinsection25.5-6-203(2)(b),inadditiontothereimbursement ratecomponentspaidpursuanttosubsections(1)to(4)ofthissection,the state department shall make a supplemental medicaid payment based uponperformancetothosenursingfacilityprovidersthatprovideservices that result in better care and higher qualityof life for their residents.
The state department shall determine the payment amount based upon performance measures established in rules adopted by the state board in the domains of quality of life, quality of care, and facility management.
-40- 270 BeginningJuly1,2024,thepaymentmustnotbelessthantwelvepercent of total provider fee payments and must be adjusted for fiscal years 2024-25 and 2025-26.
No later than July 1, 2026, the payment must not be less than fifteen percent of total provider fee payments and must be annually adjusted thereafter.
During each state fiscal year, the state department may discontinue the supplemental medicaid payment establishedpursuanttothissubsection(5)toanynursingfacilityprovider thatfailstocomplywiththeestablishedperformancemeasuresduringthe state fiscal year, and the state department may initiate the supplemental medicaid payment established pursuant to this subsection (5) to any provider that comes into compliance with the established performance measures during the state fiscal year.
(6) Subjecttoavailableappropriationsandthepriorityof theuses of the provider fees as established in section 25.5-6-203 (2)(b), in addition to the reimbursement rate components paid pursuant to subsections (1) to (5) of this section, the state department shall make a supplemental medicaid payment to nursing facility providers that serve residents:
(a) Who have severe mental health conditions that are classified at a level II by the medicaid program's preadmission screening and resident review assessment tool.
The state department shall compute this payment annually as of July 1, 2009, and each July 1 thereafter, and it must not be less than two percent of the statewide average per diem rate forthecombinedratecomponentsdeterminedpursuanttosubsections(1) to (4) of this section.
Beginning July 1, 2023, the state department shall annually adjust the rate to ensure access to care for residents who have severe mental health conditions.
-41- 270 (b) With severe dementia diseases and related disabilities or acquired brain injury.
The state department shall calculate the payment based upon the resident's cognitive assessment established in rules adopted by the state board.
The state department shall compute this payment annually as of July 1, 2009, and each July 1 thereafter, and it must not be less than one percent of the statewide average per diem rate forthecombinedratecomponentsdeterminedpursuanttosubsections(1) to (4) of this section.
Beginning July 1, 2023, the state department shall annuallyadjust the rate to ensure access to care for residents with severe dementia diseases and related disabilities or acquired brain injury.
(7) Subject to available moneys and the priorityof the uses of the providerfeesasestablishedinsection25.5-6-203(2)(b),inadditiontothe reimbursementratecomponentspaidpursuanttosubsections(1)to(6)of this section, the state department shall pay a nursing facility provider a supplemental medicaid payment for care and services rendered to medicaid residents to offset payment of the provider fee assessed under theprovisionsofsection25.5-6-203.Thestatedepartmentshallcompute this payment annually, as of July 1, 2009, and each July 1 thereafter.
(9) (b) (I) Except for changes in the number of patient days, the state department shall establish the general fund share of the aggregate statewide average of the per diemrate net of patient payment pursuant to subsections (1) to (4) of this section.
The state's share of the reimbursement rate components pursuant to subsections (1) to (4) of this section may be funded through the provider fee assessed pursuant to section25.5-6-203SECTION25.5-4-402.4(4.5)andanyassociatedfederal funds.
Any provider fee used as the state's share and all federal funds must be excluded from the calculation of the general fund share.
For the -42- 270 fiscal year commencing July 1, 2009, and for each fiscal year thereafter, the state department shall calculate the general fund share of the aggregatestatewideaverageperdiemratenetofpatientpaymentpursuant to subsections (1) to (4) of this section using the rates that were effective on July 1 of that fiscal year;
except that:
(II) Iftheaggregatestatewideaverageperdiemratenetof patient payment pursuant to subsections (1) to (4) of this section exceeds the generalfundshare,theamountoftheaveragestatewideperdiemratethat exceeds the general fund share shallST be paid as a supplemental medicaid payment using the provider fee established under section 25.5-6-203SECTION 25.5-4-402.4(4.5).Subjecttothepriorityoftheuses of the provider fee established under section 25.5-6-20SECTION) 25.5-4-402.4 (5.5)(b), if the provider fee is insufficient to fully fund the supplemental medicaid payment, the supplemental medicaid payment shallMUST be reduced to all providers proportionately.
(VI) Notwithstanding any other provision of law, for the fiscal yearcommencingJuly1,2013,andeachfiscalyearthereafter,thegeneral fund portionof theperdiemrate pursuant to subsections (1) to (4) of this section shall be reduced by one and one-half percent.
The state department may, but is not required to, increase the supplemental medicaid payment pursuant to subparagraph (II) of this paragraph (b) SUBSECTION (9)(b)(IOF THIS SECTIONdue to this reduction.
except that the provider fee shall not exceed the amount specified in section 25.5-6-203 (1)(a)(II).
(b.3)(I) ForthefiscalyearcommencingJuly1,2009,andforeach fiscal year thereafter, if the provider fee established under section 25.5-6-203 is insufficient to fully fund the supplemental medicaid -43- 270 payments established under subsections (5) to (7) of this section, subject to the priority of the uses of the provider fee established pursuant to section25.5-6-203(2)(b),thestatedepartmentmaysuspendorreducethe supplemental medicaid payment subject to the uses of the provider fee established under section 25.5-6-203.
(II) If it is determined by the state department that the case-mix reimbursement includes a factor for nursing facility providers that serve residents with severe dementia diseases and related disabilities or acquired brain injury, the state department may eliminate the supplemental medicaid payment to those providers that serve residents with severe dementia diseases and related disabilities or acquired brain injury.
(d) The reimbursement rate components pursuant to subsections (5) to (7) of this section shall be funded entirelythrough the provider fee assessed pursuant to the provisions of section 25.5-6-203 and any associatedfederalfunds.Nogeneralfundmoneysshallbeusedtopayfor the reimbursement rate components established pursuant to subsections (5) to (7) of this section.
SECTION 5.
In Colorado Revised Statutes, 25.5-6-203, repeal (1);
and add (2)(a.5) and (3) as follows:
25.5-6-203.
Nursing facilities - provider fees - federal waiver - fund created - rules - repeal.
(1) (a) (I) Beginning with the fiscal year commencing July 1, 2008, and each fiscal year thereafter, the state department shall charge and collect providerfeesonhealth-care items or services provided by nursing facility providers for the purpose of obtaining federal financial participation under the state's medical assistanceprogramasdescribedinarticles4to6ofthistitle.Asspecified -44- 270 by the priority of the uses of the provider fee in paragraph (b) of subsection (2)of thissection,theproviderfeesshallbeused to sustain or increase reimbursement for providing medical care under the state's medical assistance program for nursing facility providers.
(II) For the fiscal years commencing July 1, 2009, and July 1, 2010, the provider fee shall not exceed seven dollars and fifty cents per nonmedicare-resident day.
For the fiscal year commencing July 1, 2011, and each fiscal year thereafter, the provider fee shall not exceed twelve dollarspernonmedicare-residentdayplusinflationbasedonthenational skillednursingfacilitymarketbasketindexasdeterminedbythesecretary ofthedepartmentofhealthandhumanservicespursuantto42U.S.C.sec.
1395yy (e)(5) or any successor index.
(III) In calculating the amount of the provider fee portion of the supplemental medicaid payments established under section 25.5-6-202 (5), the state department may include an additional amount of up to five percent of the provider fee portion of said supplemental medicaid payments to initiate the payment to any provider who complies with the established performance measures during the state fiscal year.
(b) The provider fees shallbechargedona nonmedicare-resident day basis and shall be based upon the aggregate gross or net revenue, as prescribedbythestatedepartment,ofallnursingfacilityproviderssubject to the provider fee.
The statedepartmentmayexempt revenue categories from the gross or net revenue calculation and the collection of the providerfeefromnursingfacilityproviders,asauthorizedbyfederallaw.
(c)(I) Inaccordancewiththeredistributivemethodsetforthin42 CFR 433.68 (e)(1) and (e)(2), the state department shall seek a waiver from the broad-based provider fees requirement or the uniform provider -45- 270 fees requirement, or both, to exclude nursing facility providers from the provider fee.
The state department shall exempt the following nursing facility providers to obtain federal approval and minimize the financial impact on nursing facility providers:
(A) Afacilityoperatedasacontinuingcareretirementcommunity thatprovidesacontinuumofservicesbyoneoperationalentityproviding independent living services, assisted living services, and skilled nursing care on a single, contiguous campus.
Assisted living services include an assisted living residence as defined insection25-27-102orthatprovides assistedlivingserviceson-site,twenty-fourhoursperday,sevendaysper week.
(B) A skilled nursing facility owned and operated by the state;
(C) A nursing facility that is a distinct part of a facility that is licensed as a general acute care hospital;
and (D) A facility that has forty-five or fewer licensed beds.
(II) No later than July 1, 2026, the state department shall promulgaterulesmaintainingtheexemptionsidentifiedinthissubsection (1)(c) in order to minimize the financial impact on nursing facility providers.
(III) This subsection (1)(c) is repealed, effective July 1, 2028.
(d) Thestatedepartmentmaylowertheamountoftheproviderfee charged to certain nursing facility providers to meet the requirements of 42 CFR 433.68 (e) and to obtain federal approval.
(e) The imposition and collection of a provider fee shall be prohibitedwithout the federal government's approval of a state medicaid plan amendment authorizing federal financial participation for the provider fees.
The state department may alter the method prescribed in -46- 270 this section to the extent necessary to meet the federal requirements and to obtain federal approval.
(f) If the provider fee required by this subsection (1) is not approvedbythefederalgovernment,notwithstandinganyotherprovision of this section, the state department shall not implement the assessment or collection of the provider fee from nursing facility providers.
(g) The state department shall establish a schedule to assess and collecttheproviderfeeonamonthlybasis.Thestateboardshallestablish rules so that provider fee payments from a nursing facility provider and the state department's supplemental medicaid payments to the nursing facilityare due as nearlysimultaneouslyas feasible;
except that the state department'ssupplementalmedicaidpaymentstothenursingfacilityshall be due no more than fifteen days after the provider fee payment is receivedfromthenursingfacility.Thestatedepartmentshallrequireeach nursingfacilityprovidertoreportannuallyitstotalnumberofdaysofcare provided to nonmedicare residents.
(h) The state department shall not assess or collect the provider fee until state medicaid plan amendments adopting the medicaid reimbursement system for the state's class I nursing facility providers, pursuant to section 25.5-6-202, including the waiver with respect to the provider fees pursuant to this section, have been approved bythe federal government.
(i) The state board shall promulgate any rules pursuant to the "State Administrative Procedure Act", article 4 of title 24, C.R.S., necessary for the administration and implementation of this section.
(j) A nursing facilityprovidershallnotincludeanyamountof the provider fee as a separate line item in its billing statements.
-47- 270 (2)(a.5) OTWITHSTANDINGANYPROVISIONOFTHISSUBSECTION (2)TO THE CONTRARY ,ONJUNE 30, 2025THE STATE TREASURER SHALL TRANSFER THE BALANCE OF THE FUND TO THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITY NURSING FACILITY PROVIDER FEE CASH FUND CREATED IN SECTION25.5-4-402.4 (5.5).
(3) THIS SECTION IS REPEAL,EFFECTIVEJULY 1, 2025.
SECTION 6.
In Colorado Revised Statutes, 25.5-6-204, amend (1)(c) as follows:
25.5-6-204.
Providers - reimbursement - intermediate care facility for individuals with intellectual disabilities - reimbursement - maximum allowable - repeal.
(1) (c) (I) Beginning in fiscal year 2013-14, and for each fiscal year thereafter, the state department is authorizedtochargebothprivatelyownedintermediatecarefacilitiesfor individuals with intellectual disabilities and state-operated intermediate carefacilitiesforindividualswithintellectualdisabilitiesaservicefeefor the purposes of maintaining the quality and continuity of services provided by intermediate care facilities for individuals with intellectual disabilities.
The service fee charged by the state department pursuant to this paragraph (c) will be assessed pursuant to rules adopted by the state board but must not exceed five percent of the total costs incurred by all intermediate care facilities for the fiscal year in which the service fee is charged.
The state board shall adopt rules consistent with federal law in order to implement the provisions of this paragraph (c).
(II) The moneys collected in each fiscal year pursuant to subparagraph (I) of this paragraph (c) shall be transmitted by the state departmenttothestatetreasurer,whoshallcreditthesametoeservice feefundwhichfund isherebycreatedandreferredtointhisparagraph(c) -48- 270 SUBSECTION (1)(c)asthe"fund".Themoneys MONEY inthefundshallbe subject to annual appropriation by the general assembly to the state department to be used toward the state match for the federal financial participationtoreimburseintermediatecarefacilitiesforindividualswith intellectual disabilities pursuant to this section.
Any unexpended and unencumbered moneys MONEY remaining in the fund at the end of any fiscal year shall remain in the fund and not be credited or transferred to the general fund or any other fund.
(III)(A) NOTWITHSTANDINGANYPROVISIONOFTHISSUBSECTION (1)(c)TOTHECONTRARY ,ON JUNE30,2025, THESTATETREASURERSHALL TRANSFER THE BALANCE OF THE SERVICE FEE FUND TO THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITY INTERMEDIATE CARE FACILITY FEE CASH FUND CREATED IN SECTION 25.5-4-402.4 (5.7).
(B) THISSUBSECTION (1)(cISREPEALED ,EFFECTIVEJULY1,2025.
SECTION 7.
In Colorado Revised Statutes, 25.5-6-210, amend (4)(b) as follows:
25.5-6-210.
Additional supplemental payments - nursing facilities - funding methodology - reporting requirement - rules - repeal.
(4) (b) For the purposes of federal upper payment limit calculations,thestatedepartmentshallpursuefederalmatchingfundsfor payments made pursuant to this section but only after securing federal matching 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.
SECTION8.
InColoradoRevisedStatutes,25-3-108,amend(7) as follows:
25-3-108.
Receivership.(7) Thedepartmentofpublichealthand environment shall grant the receiver a license pursuant to section -49- 270 25-3-102 and shall recommend certification for medicaid participation, and the department of health care policy and financingND THE C OLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY ENTERPRISE shall reimburse the receiver for the long-term health-care facility's medicaid residents pursuant to sectionNS 25.5-6-204 C.R.S.AND 25.5-4-402.4 (5.7).
SECTION 9.
In Colorado Revised Statutes, amend 2-3-119 as follows:
2-3-119.
Audit of healthcare affordability and sustainability hospital provider fee - cost shift.
At the discretion of the legislative audit committee, the state auditor shall conduct or cause to be conducted a performance and fiscal audit of the healthcare affordability and sustainabilitySPITAL PROVIDER fee established pursuant to section 25.5-4-402.4.
SECTION10.
In Colorado RevisedStatutes,7-121-401,amend (33.5)(b)(V) as follows:
7-121-401.
Generaldefinitions.Asusedinarticles121to137of this title 7, unless the context otherwise requires:
(33.5) (b) Notwithstanding subsection (33.5)(a) of this section, "residential nonprofit corporation" does not include:
(V) A continuing care retirement community, as described in section25.5-6-203,C.R.S.ECTION25.5-4-402.4(4.5)(d)(II)(A),operated by an entity that is licensed or otherwise subject to state regulation.
SECTION11.
InColoradoRevisedStatutes,10-16-1205,amend (5)(a) as follows:
10-16-1205.
Health insurance affordability fee - special assessment on hospitals - allocation of revenues.
(5) (a) The special -50- 270 assessments on hospitals under subsection (1)(a)(II) of this section must comply with and not violate 42 CFR 433.68.
If the federal centers for medicareandmedicaidservicesintheUnitedStatesdepartmentofhealth and human services informs the state that the state will not be in compliance with 42 CFR 433.68 as a result of the special assessment on hospitals pursuant to subsection (1)(a)(II) of this section, the enterprise shall reduce the amount of the special assessment as necessary to avoid anyreduction in the healthcare affordabilityand sustainability PROVIDER fee collected pursuant to section 25.5-4-402.4.
SECTION 12.
In Colorado Revised Statutes, 25.5-4-402.8, amend (2)(g)(I) as follows:
25.5-4-402.8.
Hospitaltransparencyreportandrequirements - definitions.
(2) (g) (I) If a hospital does not provide all of the information required pursuant to subsection (2)(b) of this section, the state department shall inform the hospital of its noncompliance within sixty days and identify the information that needs to be provided.
If a hospital does not comply, the state department shall issue a corrective action plan with a timeline of sixty days required for compliance.
If a hospital continues to not comply, the state department may create a mandatory pay-for-reporting compliance measure within the hospital transformation program that is tied to the healthcare affordability and sustainabilitySPITALPROVIDER feesupplementalpaymentandisbased on compliance with subsection (2)(b) of this section.
SECTION13.
InColoradoRevisedStatutes,25.5-5-201,amend (1)(o)(II) and (1)(r)(II) as follows:
25.5-5-201.
Optional provisions - optional groups - rules.
(1) (o) (II) Notwithstanding the provisionsof subsection(1)(o)(I)of this -51- 270 section, if the money in the healthcare affordability and sustainability HOSPITAL PROVIDER fee cash fund established pursuant to section 25.5-4-402.4,togetherwiththecorrespondingfederalmatchingfunds,is insufficient to fully fund all of the purposes described in section 25.5-4-402.4(5)(b),afterreceivingrecommendationsfromtheColorado healthcareaffordabilityandsustainabilityenterpriseestablishedpursuant to section 25.5-4-402.4 (3), for individuals with disabilities who are participating in the medicaid buy-in program established in part 14 of article 6 of this title 25.5, the state board by rule adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III) may reduce the medical benefits offered or the percentage of the federal poverty line to below four hundred fifty percent or may eliminate this eligibility group.
(r) (II) Notwithstanding the provisions of subsection (1)(r)(I) of thissection,ifthemoneyinthehealthcareaffordabilityandsustainability HOSPITAL PROVIDER fee cash fund established pursuant to section 25.5-4-402.4,togetherwiththecorrespondingfederalmatchingfunds,is insufficient to fully fund all of the purposes described in section 25.5-4-402.4(5)(b),afterreceivingrecommendationsfromtheColorado healthcareaffordabilityandsustainabilityenterpriseestablishedpursuant to section 25.5-4-402.4 (3), for persons eligible for a medicaid buy-in program established pursuant to section 25.5-5-206, the state board by ruleadoptedpursuanttotheprovisionsofsection25.5-4-402.4(6)(b)(III) mayreduce the medical benefits offered, or the percentage of the federal poverty line, or may eliminate this eligibility group.
SECTION 14.
In Colorado Revised Statutes, 25.5-5-204.5, amend (2) as follows:
25.5-5-204.5.
Continuous eligibility- children.
-52- 270 (2) Notwithstandingtheprovisionsofsubsection(1)ofthissection,ifthe money in the healthcare affordability and sustainabilityPITAL PROVIDER fee cash fund established pursuant to section 25.5-4-402.4, togetherwiththecorrespondingfederalmatchingfunds,isinsufficientto fully fund all of the purposes described in section 25.5-4-402.4 (5)(b), after receiving recommendations from the Colorado healthcare affordabilityand sustainabilityenterprise established pursuant to section 25.5-4-402.4 (3), the state board by rule adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III) may eliminate the continuous enrollment requirement pursuant to this section.
SECTION 15.
In Colorado Revised Statutes, 25.5-6-1403, amend (5)(b) as follows:
25.5-6-1403.
Waivers and amendments.
(5) (b) The state department shall not prepare and submit the amendments to the state medical assistance plan pursuant to this subsection (5) if there are insufficient revenues fromthe healthcare affordabilityand sustainability HOSPITALPROVIDER feecashfund,createdinsection25.5-4-402.4,forthe administrative expenses associated with preparing and submitting the state plan amendments.
If there are insufficient revenues from the healthcare affordability and sustainabilityL PROVIDER fee cash fund, the state department may accept and expend gifts, grants, or donations for this purpose.
SECTION16.
InColoradoRevisedStatutes,25.5-8-103,amend (4)(a)(II) and (4)(b)(II) as follows:
25.5-8-103.
Definitions - rules.
As used in this article 8, unless the context otherwise requires:
(4) "Eligible person" means:
-53- 270 (a) (II) Notwithstanding the provisions of subsection (4)(a)(I) of thissection,ifthemoneyinthehealthcareaffordabilityandsustainability HOSPITAL PROVIDER fee cash fund established pursuant to section 25.5-4-402.4(5),togetherwiththecorrespondingfederalmatchingfunds, is insufficient to fully fund all of the purposes described in section 25.5-4-402.4(5)(b),afterreceivingrecommendationsfromtheColorado healthcareaffordabilityandsustainabilityenterpriseestablishedpursuant to section 25.5-4-402.4 (3), for persons less than nineteen years of age, the state board maybyrule adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III) reduce the percentage of the federal povertyline to below two hundred sixty percent, but the percentage shall not be reduced to below two hundred thirteen percent.
(b) (II) Notwithstanding the provisions of subsection (4)(b)(I) of thissection,ifthemoneyinthehealthcareaffordabilityandsustainability HOSPITAL PROVIDER fee cash fund established pursuant to section 25.5-4-402.4(5),togetherwiththecorrespondingfederalmatchingfunds, is insufficient to fully fund all of the purposes described in section 25.5-4-402.4(5)(b),afterreceivingrecommendationsfromtheColorado healthcareaffordabilityandsustainabilityenterpriseestablishedpursuant to section 25.5-4-402.4 (3), for pregnant women, the state board by rule adoptedpursuanttotheprovisionsofsection25.5-4-402.4(6)(b)(III)may reduce the percentage of the federal poverty line to below two hundred sixty percent, but the percentage shall not be reduced to below two hundred thirteen percent.
SECTION 17.
Appropriation - adjustments to 2025 long bill.
(1) To implement this act, appropriations made in the annual general appropriation act for the 2025-26 state fiscal year to the department of -54- 270 health care policy and financing from the Medicaid nursing facilitycash fund created in section 25.5-6-203 (2)(a), C.R.S., are decreased as follows:
Executive director's office, general administration Personal services $246,811 Health, life, and dental $30,953 Short-term disability $65 Paid family and medical leave insurance $1,153 Unfunded liability amortization equalization disbursement payments $15,605 Salary survey $6,899 Step pay $461 PERA direct distribution $5,026 Workers' compensation $788 Operating expenses $13,200 Payment to risk management and property funds $772 Leased space $17,191 Payments to OIT $59,513 CORE operations $123 General professional services and special projects $1,250 Executive director's office, utilization and quality review contracts Professional services contracts $36,875 Executive director's office, provider audits and services Professional audit contracts $12,420 Executive director's office, indirect cost recoveries Indirect cost assessment $12,116 -55- 270 Medical services premiums Medical and long-term care services for Medicaid eligible individuals $62,525,000 (2) For the 2025-26 state fiscal year, $62,986,221 is appropriated to the department of health care policyand financing.
This appropriation is from the healthcare affordability and sustainability nursing facility providerfeecashfundcreatedinsection25.5-4-402.4(5.5)(a),C.R.S.To implementthisact,thedepartmentmayusethisappropriationasfollows:
Executive director's office, general administration Personal services $246,811 Health, life, and dental $30,953 Short-term disability $65 Paid family and medical leave insurance $1,153 Unfunded liability amortization equalization disbursement payments $15,605 Salary survey $6,899 Step pay $461 PERA direct distribution $5,026 Workers' compensation $788 Operating expenses $13,200 Payment to risk management and property funds $772 Leased space $17,191 Payments to OIT $59,513 CORE operations $123 General professional services and special projects $1,250 Executive director's office, utilization and quality review contracts -56- 270 Professional services contracts $36,875 Executive director's office, provider audits and services Professional audit contracts $12,420 Executive director's office, indirect cost recoveries Indirect cost assessment $12,116 Medical services premiums Medical and long-term care services for Medicaid eligible individuals $62,525,000 (3) To implement this act, appropriations made in the annual general appropriation act for the 2025-26 state fiscal year to the department of health 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:
Executive director's office, general administration Personal services $36,476 Health, life, and dental $4,955 Short-term disability $15 Paid family and medical leave insurance $169 Unfunded liability amortization equalization disbursement payments $2,287 Salary survey $1,150 Step pay $67 PERA direct distribution $737 Workers' compensation $116 Operating expenses $1,876 Payment to risk management and property funds $114 Leased space $2,371 Payments to OIT $8,789 -57- 270 CORE operations $18 Executive director's office, indirect cost recoveries Indirect cost assessment $1,778 Medical services premiums Medical and long-term care services for Medicaid eligible individuals $200,460 Transfers to other statedepartment Medicaid-funded programs, human services Regional centers for people with developmental disabilities $1,888,903 (4) Forthe2025-26statefiscalyear,$2,150,281isappropriatedtothe departmentofhealthcarepolicyandfinancing.Thisappropriationisfrom the healthcare affordability and sustainability intermediate care facility fee cash fund created in section 25.5-4-402.4 (5.7)(a), C.R.S.
To implementthisact,thedepartmentmayusethisappropriationasfollows:
Executive director's office, general administration Personal services $36,476 Health, life, and dental $4,955 Short-term disability $15 Paid family and medical leave insurance $169 Unfunded liability amortization equalization disbursement payments $2,287 Salary survey $1,150 Step pay $67 PERA direct distribution $737 Workers' compensation $116 Operating expenses $1,876 -58- 270 Payment to risk management and property funds $114 Leased space $2,371 Payments to OIT $8,789 CORE operations $18 Executive director's office, indirect cost recoveries Indirect cost assessment $1,778 Medical services premiums Medical and long-term care services for Medicaid eligible individuals $200,460 Transfers to other statedepartment Medicaid-funded programs, human services Regional centers for people with developmental disabilities $1,888,903 -59- 270 APPROPRIATION FROM ITEM & TOTAL GENERAL GENERAL CASH REAPPROPRIATED FEDERAL SUBTOTAL FUND FUND FUNDS FUNDS FUNDS EXEMPT $ $ $ $ $ $ $ SECTION 18.
Appropriation to the department of health care policy and financing for the fiscal year beginning July 1, 2024.
In Session Laws of Colorado 2024, section 2 of chapter 519, (HB 24-1430), amend Part VI (2) and (7)(C)(6), as Part VI (2) and the affected totals are amended by section 1 of SB 25-093, as follows:
Section 2.
Appropriation.
PART VI DEPARTMENT OF HEALTH CARE POLICY AND FINANCING (2) MEDICAL SERVICES PREMIUMS Medical and Long-Term Care Services for Medicaid Eligible Individuals 12,081,998,495 2,376,915,878(M) 1,247,280,333 1,399,855,214b 119,588,730c 6,938,358,340 aThis amount shall be from the General Fund Exempt Account created in Section 24-77-103.6 (2), C.R.S.
-60- 270 APPROPRIATION FROM ITEM & TOTAL GENERAL GENERAL CASH REAPPROPRIATED FEDERAL SUBTOTAL FUND FUND FUNDS FUNDS FUNDS EXEMPT $ $ $ $ $ $ $ bOf this amount, $1,062,923,207 shall be fromthe Healthcare Affordabilityand SustainabilityFee Cash Fund created in Section 25.5-4-402.4 (5)(a), C.R.S., $76,010,738 shall be from recoveriesandrecoupments,$58,197,24$48,415,351shallbefromtheMedicaidNursingFacilityCashFundcreatedinSection25.5-6-203(2)(a),C.R.S.,$54,010,364representspublic funds certified as expenditures incurred by public emergency medical transportation providers, $52,400,466 shall be from the Adult Dental Fund created in Section 25.5-5-207 (4)(a), C.R.S.,$46,929,200shallbefromtheHealthCareExpansionFundcreatedinSection24-22-117(2)(a)(I),C.R.S.,$24,736,077representspublicfundscertifiedasexpendituresincurred by public hospitals and agencies that are eligible for federal financial participation under the Medicaid program, $20,376,822 shall be from the Home- and Community-based Services Improvement Fund created in Section 25.5-6-1805 (1), C.R.S., $9,SHALL BE FROM THEH EALTHCARE A FFORDABILITY ANDSUSTAINABILITY NURSING FACILITY PROVIDER FEE CASH FUND CREATED IN SECTION 25.5-4-402.4 (5.5)(a), C.R.S., $1,491,000 shall be from the Tobacco Tax Cash Fund created in section 24-22-117 (1)(a), C.R.S., and meets the requirement to appropriate a portion of the revenues collected from the imposition of additional state cigarette and tobacco taxes to the Old Age Pension program for health related purposes pursuant to Section 21 of Article X of the State Constitution, $857,151 shall be from the Tobacco Education Programs Fund created in Section 24-22-117 (2)(c)(I), C.R.S., $700,000 shall be from an intergovernmental transfer from Denver Health, $550,798 shall be from the Breast and Cervical Cancer Prevention and Treatment Fund created in Section 25.5-5-308(8)(a)(I),C.R.S.,$471,682shallbefromtheARPAHome-and Community-Based ServicesAccountcreatedinSection25.5-4-402.4(5)(c)(I)(A),C.R.S.,and$200,460shall be from the Service Fee Fund created in Section 25.5-6-204 (1)(c)(II), C.R.S.
c Of this amount, $107,671,715 shall be transferred from the Department of Higher Education from the Fee-for-service Contracts with State Institutions for Speciality Education Programs line item, $9,253,841 shall be transferred from the Old Age Pension State Medical Program line item appropriation in the Other Medical Services division of this department, $1,505,000 shall be from the Department of Early Childhood from the Home Visiting line item, and $1,158,174 shall be transferred from Public School Health Services line item in the Other Medical Services division of this department.
-61- 270 APPROPRIATION FROM ITEM & TOTAL GENERAL GENERAL CASH REAPPROPRIATED FEDERAL SUBTOTAL FUND FUND FUNDS FUNDS FUNDS EXEMPT $ $ $ $ $ $ $ (7) TRANSFERS TO OTHER STATE DEPARTMENT MEDICAID-FUNDED PROGRAMS (C) Human Services (6) Office of Adults, Aging and Disability Services Administration 505,357 252,679(M) 252,678 Regional Centers for People with Developmental Disabilities 58,276,921 27,249,558(M) 1,888,903a 29,138,460 Community Services for the Elderly 1,001,800 500,900(M) 500,900 59,784,078 aThis OF THISamount $1,530,432 shall be from the Service Fee Fund created in Section 25.5-6-204 (1)(ANDI$358,471SHALL BE FROM THEH EALTHCARE A FFORDABILITY ANDSUSTAINABILITYINTERMEDIATE CARE FACILITYC ASHFUND CREATED IN SECTION25.5-4-402.4 (5.7)(a), C.R.S.
-62- 270 APPROPRIATION FROM ITEM & TOTAL GENERAL GENERAL CASH REAPPROPRIATED FEDERAL SUBTOTAL FUND FUND FUNDS FUNDS FUNDS EXEMPT $ $ $ $ $ $ $ TOTALS PART VI (HEALTH CARE POLICY AND a b c FINANCING) $16,304,072,844 $3,819,066,512 $1,247,571,367 $1,913,251,446 $137,592,164 $9,186,591,355 aOf this amount, $1,247,280,333 shall be from the General Fund Exempt Account created in Section 24-77-103.6 (2), C.R.S., and $291,034 shall be General Fund Exempt pursuant to Section 24-22-117 (1)(c)(I)(B.5), C.R.S.
Said $291,034 is not subject to the statutory limitation on General Fund appropriations imposed by Section 24-75-201.1, C.R.S.
bOf this amount, $19,254,185 contains an (I) notation.
cOf this amount, $438,736,989 contains an (I) notation.
-63- 270 SECTION 19.
Effective date.
This act takes effect May 1, 2025.
SECTION 20.
Safety clause.
The general assembly finds, determines, and declares that this act is necessary for the immediate preservationofthepublicpeace,health,orsafetyorforappropriationsfor the support and maintenance of the departments of the state and state institutions.
-64- 270