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January 28, 2022 HB 22-1068
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 22-0116
Rep. McCormick
Sen. Jaquez Lewis
Date:
Bill Status:
Fiscal Analyst:
January 28, 2022
House HHS
Erin Reynolds | 303-866-4146
Erin.Reynolds@state.co.us
Bill Topic: MEDICAID REIMBURSEMENT FOR THERAPY USING EQUINES
Summary of
Fiscal Impact:
☐ State Revenue
☒ State Expenditure
☐ State Transfer
☐ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
Conditional upon federal approval, the bill makes Medicaid reimbursement available
for certain therapies using equine movement. It will increase state expenditures on an
ongoing basis beginning in FY 2022-23.
Appropriation
Summary:
For FY 2022-23, the bill requires an appropriation of $139,315 to the Department of
Health Care Policy and Financing.
Fiscal Note
Status:
The fiscal note reflects the introduced bill.
Table 1
State Fiscal Impacts Under HB 22-1068
Budget Year
FY 2022-23
Out Year
FY 2023-24
Out Year
FY 2024-25
Revenue - - -
Expenditures General Fund $89,464 $319,989 $338,750
Federal Funds $49,851 $319,988 $338,750
Centrally Appropriated $22,048 $23,634 $23,634
Total Expenditures $161,363 $663,611 $701,134
Total FTE 0.9 FTE 1.0 FTE 1.0 FTE
Transfers - - -
Other Budget Impacts General Fund Reserve $13,420 $47,998 $50,813
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January 28, 2022 HB 22-1068
Summary of Legislation
Subject to federal authorization and federal financial participation, on or after January 1, 2023, the bill
makes Medicaid reimbursement available for therapy using equine movement when provided by a
physical therapist, occupational therapist, or speech-language pathologist.
Background
Therapy using equine movement, or hippotherapy, is a physical therapy, occupational therapy, and
speech-language pathology treatment strategy that uses the multidimensional movement of the horse
to improve neuromuscular function and sensory processing in children and adults with movement
dysfunction.
Medicaid has provided some states with Section 1115 demonstration waivers to test new or existing
ways to deliver and pay for health care services, and Colorado has been authorized for hippotherapy
for some members under three Center for Medicaid Services (CMS) waivers:
Children’s Extensive Support (CES) Waiver;
Home and Community Based Services-Children’s Habilitation Residential Program (CHRP); and
Supported Living Services (SLS).
State Expenditures
The bill increases state expenditures in the Department of Health Care Policy and Financing by
$161,363 in FY 2022-23, $663,611 in FY 2023-24, and $701,134 in FY 2024-25 from the General Fund and
federal funds. Expenditures are shown in Table 2 and detailed below.
Table 2
Expenditures Under HB 22-1068
FY 2022-23 FY 2023-24 FY 2024-25
Department of Health Care Policy and Financing
Personal Services $71,677 $78,193 $78,193
Operating Expenses $1,350 $1,350 $1,350
Capital Outlay Costs $6,200 - -
Projected Service Expenditures $502,159 $1,041,839 $1,079,361
Current Service Expenditures
1
($442,071) ($481,405) ($481,404)
Centrally Appropriated Costs
2
$22,048 $23,634 $23,634
Total $161,363 $663,611 $701,134
Total FTE 0.9 FTE 1.0 FTE 1.0 FTE
1
Current service expenditures include FY 2020-21 spending for Adult Supported Living Services and Children's
Extensive Support Services. Children's Habilitation Residential Programs had no spending in FY 2020-21.
2
Centrally appropriated costs are not included in the bill's appropriation. Page 3
January 28, 2022 HB 22-1068
Department of Health Care Policy and Financing. The Department of Health Care Policy and
Financing (HCPF) requires 1.0 FTE Rate/Financial Analyst III and existing staff to:
establish an implementation plan for CMS review prior to January 1, 2023—the position requires
General Fund until CMS approval is secured, and additional General Funds may be required if
approval is delayed;
complete waiver amendments for CES, CHRP, and SLS to remove hippotherapy or determine
whether additional units should be available to members meeting certain criteria;
make conforming contract modifications and provide training;
develop a rate methodology related to hippotherapy; and
measure performance outcomes, as required by CMS.
Additional MMIS programming costs may be incurred if the service needs are determined to be
unique, and the current procedure codes inadequate. This will be addressed through the annual
budget process once this impact is known.
Projected and current service expenditures. Service expenditures anticipate federal approval. It is
assumed that service costs will increase as hippotherapy eligibility is expanded to the whole Medicaid
population from the more limited eligibility currently under the HCBS waiver programs, which will
increase spending on Medical Service Premiums. Benefits will be capped based on the number of
certified providers in the state that could provide this service. While just over 1 percent of the
Medicaid population is estimated to be eligible, lack of providers inhibits the full utilization of the
service. After the first year of implementation, caseloads will be captured in HCPF's forecast during
the annual budget process.
Centrally appropriated costs. Pursuant to a Joint Budget Committee policy, certain costs associated with
this bill are addressed through the annual budget process and centrally appropriated in the Long Bill or
supplemental appropriations bills, rather than in this bill. These costs, which include employee insurance
and supplemental employee retirement payments, are shown in Table 2.
Other Budget Impacts
General Fund reserve. Under current law, an amount equal to 15 percent of General Fund
appropriations must be set aside in the General Fund statutory reserve beginning in FY 2022-23. Based
on this fiscal note, the bill is expected to increase the amount of General Fund held in reserve by
$13,420 in FY 2022-23, $47,998 in FY 2023-24, and $50,813 in FY 2024-25, which will decrease the
amount of General Fund available for other purposes.
Technical Note
Program implementation is dependent on federal financial participation by CMS. CMS only approves
plan amendments in July and January, which may create a slight implementation delay.
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January 28, 2022 HB 22-1068
Effective Date
The bill takes effect upon signature of the Governor, or upon becoming law without his signature.
State Appropriations
For FY 2022-23, the bill requires appropriations totaling $139,315 to the Department of Health Care
Policy and Financing, including:
$89,464 from the General Fund; and
$49,851 from federal funds; with
0.9 FTE.
State and Local Government Contacts
Health Care Policy and Financing Information Technology Regulatory Agencies
The revenue and expenditure impacts in this fiscal note represent changes from current law under the bill for each
fiscal year. For additional information about fiscal notes, please visit: leg.colorado.gov/fiscalnotes.