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March 29, 2022 HB 22-1114
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Revised Fiscal Note
(replaces fiscal note dated February 10, 2022)
Drafting Number:
Prime Sponsors:
LLS 22-0413
Rep. Larson; Valdez A.
Date:
Bill Status:
Fiscal Analyst:
March 29, 2022
House Appropriations
Erin Reynolds | 303-866-4146
Erin.Reynolds@state.co.us
Bill Topic: TRANSPORTATION SERVICES FOR MEDICAID WAIVER RECIPIENTS
Summary of
Fiscal Impact:
☐ State Revenue
☒ State Expenditure
☐ State Transfer
☐ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
The bill authorizes a transportation network company to provide non-medical
transportation services to persons enrolled in certain Medicaid waiver programs
beginning July 1, 2024. 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 $547,674 to the Department of
Health Care Policy and Financing.
Fiscal Note
Status:
The revised fiscal note reflects the introduced bill, as amended by the House Public
and Behavioral Health and Human Services Committee.
Table 1
State Fiscal Impacts Under HB 22-1114
Budget Year
FY 2022-23
Out Year
FY 2023-24
Out Year
FY 2024-25
Out Year
FY 2025-26
Revenue
- - - -
Expenditures General Fund $88,411 $36,282 $270,000 $540,000
Cash Funds $22,400 $19,833 - -
Federal Funds $436,863 $344,801 $270,000 $540,000
Total Expenditures $547,674 $400,916 $540,000 $1,080,000
Transfers - - - -
Other Budget Impacts General Fund Reserve $13,262 $5,442 $40,500 $81,000
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March 29, 2022 HB 22-1114
Summary of Legislation
The bill requires the Department of Health Care Policy and Financing (HCPF) to submit a report to the
legislature by January 2024 identifying ways to incentivize and increase transportation provider
participation for persons enrolled in the following Medicaid waiver programs:
the Brain Injury Waiver (BI);
the Developmental Disabilities Waiver (DD);
the Community Mental Health Supports Waiver (CMHS);
the Elderly, Blind and Disabled Waiver (EBD); and
the Spinal Cord Injury Waiver (SCI).
The report must identify a reimbursement system, compliance procedures, a common reporting
system, and other best practices, and must be informed by a stakeholder engagement process.
Following report completion, HCPF must analyze and review each operational TNC and verify its
ability to ensure health, safety, welfare, cost effectiveness, and capability in expanding non-medical
transportation services.
By July 1, 2024, HCPF must authorize verified TNCs to provide services if the TNC is viable under
federal requirements and within budgetary constraints. HCPF may seek any necessary federal
authorization and promulgate any necessary rules to ensure compliances with federal and state
oversight requirements. TNCs are not subject to Public Utilities Commission regulation when
providing non-medical transportation services.
Background
Non-medical transportation (NMT) and non-emergency medical transportation (NEMT) are required
Medicaid benefits available on all six adult waiver programs, including BI, CMHS, DD, EBD, SCI, and
the Supported Living Services Waiver (SLS). Currently, these transportation services are provided by
credentialed drivers, as well as taxi service, mobility vans, and public transportation, where available.
Reimbursement for these services utilizes fee-for-service, negotiated market price, and public pricing
rate methodologies and is calculated by multiplying the rate by the number of units utilized. HCPF
also oversees the safety and oversight of Medicaid NMT and NEMT services.
Transportation network companies are services that use a digital network to connect riders to drivers
for the purpose of providing transportation, such as Lyft and Uber.
Data and Assumptions.
For the BI, CMHS, EBD, and SCI waiver, trips are limited to 208 trips, or 104 round trips, per service
plan year, excluding trips to and from adult day services. For the DD waiver, there is a maximum of
508 trips, or 254 round trips, per service plan year. Most waiver recipients do not fully utilize their
ride maximums. The fiscal note assumes that the approval of TNCs to provide non-medical
transportation will increase usage by 20 percent.
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March 29, 2022 HB 22-1114
State Expenditures
The bill increases state expenditures in HCPF by the amounts shown in Table 2 from the General Fund,
cash funds, and federal funds. These impacts are detailed below.
Table 2
Expenditures Under HB 22-1114
FY 2022-23 FY 2023-24 FY 2024-25 FY 2025-26
Department of Health Care Policy and Financing
Contract Business Analyst $201,600 $148,000 - -
Contract Policy Advisor $124,230 $26,000 - -
MMIS Programming $221,844 $226,916 - -
Service Costs - - $540,000 $1,080,000
Total Cost $547,674 $400,916 $540,000 $1,080,000
General Fund $88,411 $36,282 $270,000 $540,000
Cash Funds $22,400 $19,833 - -
Federal Funds $436,863 $344,801 $270,000 $540,000
Health Care Policy and Financing. Costs in HCPF include contract staff, computer programming,
and increased service costs, as discussed below.
Staff. HCPF requires contract support from a business analyst and policy advisor over two years.
The business analyst will coordinate the systems updates between multiple systems vendors and
departmental programs. Business analyst costs assume 1,120 hours at $180 per hour in FY 2022-23
and 800 hours at $185 per hour in FY 2023-24. The policy advisor will identify a reimbursement
system, a reporting system, compliance procedures, and engage in a stakeholder process, among
other tasks. Policy analyst costs assume 615 hours at $202 per hour in FY 2022-23 and 125 hours
at $208 per hour in FY 2023-24. Existing department staff will promulgate rules, submit waiver
amendments, and work with contract staff within existing resources.
MMIS programming. Programming costs for the Medicaid Management Information System
assume 1,596 hours in each of FY 2022-23 and FY 2023-24 at an hourly cost of $139 in FY 2022-23
and $142 in FY 2023-24.
Service costs. HCPF data show that there are approximately 2,250 applicable waiver participants
currently utilizing NMT taxi services at a monthly cost of $200. The fiscal note assumes a
20 percent increase in utilization due to the ease and availability of transportation network
company services. FY 2024-25 costs reflect half-year utilization to account for a ramp-up period.
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March 29, 2022 HB 22-1114
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
amounts shown in Table 1, which will decrease the amount of General Fund available for other
purposes.
Effective Date
The bill takes effect 90 days following adjournment of the General Assembly sine die, assuming no
referendum petition is filed.
State Appropriations
For FY 2022-23, the bill requires the following appropriations to the Department of Health Care Policy
and Financing:
$88,411 from the General Fund;
$22,400 from cash funds; and
$436,863 from federal funds.
State and Local Government Contacts
Health Care Policy and Financing Information Technology
Law 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.