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February 21, 2022 HB 22-1068
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Revised Fiscal Note
(replaces fiscal note dated January 28, 2022)
Drafting Number:
Prime Sponsors:
LLS 22-0116
Rep. McCormick; Lynch
Sen. Jaquez Lewis
Date:
Bill Status:
Fiscal Analyst:
February 21, 2022
House Appropriations
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 workload beginning
in FY 2022-23 and state expenditures beginning in FY 2024-25.
Appropriation
Summary:
No appropriation is required.
Fiscal Note
Status:
The fiscal note reflects the introduced bill, as amended by the House Public and
Behavioral Health and Human Services Committee. It has also been updated to reflect
new information.
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 - - $61,610
Federal Funds - - $61,610
Total Expenditures - - $123,220
Transfers - - -
Other Budget Impacts General Fund Reserve - - $9,242
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February 21, 2022 HB 22-1068
Summary of Legislation
Subject to federal authorization and federal financial participation, on or after July 1, 2024, the bill
makes Medicaid reimbursement available for therapy using equine movement when provided by a
physical therapist, occupational therapist, or speech-language pathologist.
Background
Equine therapy 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 equine therapy
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 workload and expenditures in the Department of Health Care Policy and
Financing (HCPF) beginning in FY 2022-23.
Projected service expenditures. The fiscal note assumes federal approval will be granted to allow for
equine therapy as a physical, occupational, or speech therapy for the state's Medicaid population.
Currently, 161 people receive equine therapy through waivers at a reimbursement rate of $21; and
under the bill, this population will receive equine therapy through Medicaid at a reimbursement rate
of $31 used for other forms of physical, occupational, or speech therapy. Annually, this population
uses 12,322 service units; therefore, a $10 increase in per unit reimbursement will increase costs by
about $123,220 per year, with 50 percent coming from federal funds.
Other than the waiver recipients, the fiscal note assumes the bill's impact on medical services
premiums will be minimal since equine therapy will be provided within the existing physical,
occupation, and speech therapy structure, and does not increase eligibility. After the first year of
implementation in FY 2024-25, any caseload impact will be captured in HCPF's forecast during the
annual budget process.
Waiver-related workload. Staff will establish an implementation plan for federal review; complete
any necessary waiver amendments for CES, CHRP, and SLS; make conforming contract modifications;
provide training; and measure performance outcomes. This work can be accomplished within existing
appropriations.
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February 21, 2022 HB 22-1068
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 the
amount shown in Table 1 in FY 2024-25 and ongoing, which will decrease the amount of General Fund
available for other purposes.
Effective Date
The bill takes effect upon signature of the Governor, or upon becoming law without his signature.
Departmental Difference
HCPF estimates medical services costs of $1.3 million per year beginning in FY 2024-25, assuming that
equine therapy will be provided in addition to, rather than a one-to-one substitution for, currently
utilized physical, occupational, and speech therapy modalities. HCPF's cost methodology assumes
that 560 Medicaid recipients will utilize equine therapy in addition to current therapies, based on
current participation through the waivers and limited by provider availability. The fiscal note
assumes that the number of referrals and approved service hours for physical, occupational, and
speech therapy will remain constant, and that equine therapy will be used within those service
amounts.
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.