HOUSE BILL 22-1268
BY REPRESENTATIVE(S) Holtorf and Amabile, Bernett, Bird,
Boesenecker, Kipp, Lontine, Michaelson Jenet, Titone, Weissman;
also SENATOR(S) Ginal and Simpson, Hinrichsen, Jaquez Lewis,
Kirkmeyer, Kolker, Lee, Liston, Moreno, Rodriguez, Sonnenberg,
Zenzinger, Fenberg.
C
ONCERNING A REPORTING OF MEDICAID REIMBURSEMENT RATES PAID TO
MENTAL HEALTH PROVIDERS
.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. Legislative declaration. The general assembly finds
and declares that it is imperative to determine whether a disparity exists, and
the reasons for such possible disparities, in medicaid reimbursement rates
among providers of mental health services in an effort to ensure
transparency and parity in reimbursement rates.
SECTION 2. In Colorado Revised Statutes, add 25.5-1-132 as
follows:
25.5-1-132. Report of medicaid reimbursement rates paid to
community mental health center providers and independent providers
NOTE: This bill has been prepared for the signatures of the appropriate legislative
officers and the Governor. To determine whether the Governor has signed the bill
or taken other action on it, please consult the legislative status sheet, the legislative
history, or the Session Laws.
________
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act. - definition. (1) O N OR BEFORE AUGUST 15, 2022, THE STATE DEPARTMENT
SHALL PUBLISH A BEHAVIORAL HEALTH RATES REPORT OF MEDICAID
REIMBURSEMENT RATES FOR PROVIDERS OF COMMUNITY MENTAL HEALTH
CENTERS
, AS DEFINED IN SECTION 27-66-101 (2), AND INDEPENDENT MENTAL
HEALTH AND SUBSTANCE ABUSE TREATMENT PROVIDERS
, AS DESCRIBED IN
SUBSECTION
(2) OF THIS SECTION. THE STATE DEPARTMENT SHALL
CONTRACT WITH AN INDEPENDENT AUDITOR TO PREPARE THE BEHAVIORAL
HEALTH RATES REPORT
, AS DESCRIBED IN THIS SUBSECTION (1). THE STATE
DEPARTMENT SHALL PREPARE
, IN COORDINATION WITH THE BEHAVIORAL
HEALTH RATES REPORT
, A SET OF RECOMMENDATIONS ON CREATING
EQUITABLE PAYMENT AND PAYMENT MODELS THAT MINIMIZE
INAPPROPRIATE PAYMENT VARIATION IN COMPARABLE BEHAVIORAL HEALTH
SERVICES BETWEEN THE PROVIDERS OF COMMUNITY MENTAL HEALTH
CENTERS AND INDEPENDENT MENTAL HEALTH AND SUBSTANCE USE
TREATMENT PROVIDERS
. THE STATE DEPARTMENT SHALL PRESENT THE
BEHAVIORAL HEALTH RATES REPORT AND RECOMMENDATIONS TO THE
HOUSE OF REPRESENTATIVES PUBLIC AND BEHAVIORAL HEALTH AND HUMAN
SERVICES COMMITTEE
, OR ANY SUCCESSOR COMMITTEE .
(2) T
HE REPORT PREPARED PURSUANT TO SUBSECTION (1) OF THIS
SECTION MUST REFLECT DATA FROM STATE FISCAL YEAR
2020-21 AND
IDENTIFY DISCREPANCIES
, IF ANY, AND THE REASONS FOR SUCH
DISCREPANCIES IN MEDICAID REIMBURSEMENT RATES PAID TO PROVIDERS OF
A COMMUNITY MENTAL HEALTH CENTER AND INDEPENDENT MENTAL HEALTH
AND SUBSTANCE ABUSE TREATMENT PROVIDERS FOR COMPARABLE
SERVICES
. THE REPORT MUST INCLUDE A DETERMINATION OF AND
RECOMMENDATIONS ON WHETHER REIMBURSEMENT RATES PAID TO
COMMUNITY MENTAL HEALTH CENTER PROVIDERS AND INDEPENDENT
MENTAL HEALTH AND SUBSTANCE USE TREATMENT PROVIDERS ARE
ADEQUATE TO MEET OR EXCEED NETWORK ADEQUACY ST ANDARDS IN EVERY
REGION OF THE STATE
. THE DATA MUST BE AGGREGATED TO ENSURE
INDIVIDUAL COMMUNITY MENTAL HEALTH CENTERS AND INDEPENDENT
PROVIDERS ARE NOT IDENTIFIABLE AND MUST COMPLY WITH ANY OTHER
STATE AND FEDERAL PRIVACY LAWS
. ON OR BEFORE NOVEMBER 15, 2022,
THE STATE DEPARTMENT SHALL PRESENT AN ACTION PLAN FOR
IMPLEMENTATION TO THE JOINT BUDGET COMMITTEE
. THE STATE
DEPARTMENT SHALL PRODUCE A PROGRESS REPORT ON THE STATE
DEPARTMENT
'S PROGRESS MADE IN IMPLEMENTING THE ACTION PLAN
PRESENTED TO THE JOINT BUDGET COMMITTEE ON
NOVEMBER 15, 2022, ON
OR BEFORE
AUGUST 1, 2023, AND ANNUALLY THEREAFTER THROUGH
PAGE 2-HOUSE BILL 22-1268 AUGUST 1, 2025, AND PROVIDE AN UPDATE DURING ITS "STATE
MEASUREMENT FOR ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT
(SMART) GOVERNMENT ACT" HEARING PURSUANT TO SECTION 2-7-203 ON
THE FINDINGS AND ADDITIONAL RECOMMENDATIONS
. THE STATE
DEPARTMENT MUST FULLY IMPLEMENT THE ACTION PLAN NO LATER THAN
DECEMBER 31, 2025.
(3) A
S USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE
REQUIRES
, "INDEPENDENT MENTAL HEALTH AND SUBSTANCE ABUSE
TREATMENT PROVIDERS
" MEANS ANY OUTPATIENT BEHAVIORAL HEALTH
PROVIDER ENROLLED IN MEDICAID AND CONTRACTED WITH A M ANAGED
CARE ENTITY
, AS DEFINED IN SECTION 25.5-5-403 (4), THAT IS NOT LICENSED
OR DESIGNATED AS A COMMUNITY MENTAL HEALTH CENTER
.
SECTION 3. In Colorado Revised Statutes, add 25.5-4-403.1 as
follows:
25.5-4-403.1. Providers - community mental health centers - cost
reporting. (1) F
OR THE PURPOSES OF INCREASED PAYMENT METHODOLOGY
TRANSPARENCY
, NO LATER THAN MARCH 15, 2023, AND EACH MARCH 15
THEREAFTER, THE STATE DEPARTMENT SHALL :
(a) P
UBLISH COST REPORTS FOR COMMUNITY MENTAL HEALTH
CENTERS
;
(b) E
STABLISH A COST-REPORTING TEMPLATE AND COST -REPORTING
SCHEDULE TO ASSIST PROVIDERS IN PROVIDING COST REPORTS
;
(c) R
EDACT INFORMATION TO MAINTAIN COMPLIANCE WITH STATE
AND FEDERAL LAW INCLUDING
, BUT NOT LIMITED TO , PERSONALLY
IDENTIFYING INFORMATION AND PROTECTED HEALTH INFORMATION AS
NECESSARY TO PROTECT THE PRIVACY OF PATIENTS
;
(d) C
REATE A PUBLICLY AVAILABLE WEBSITE THAT PROVIDES
INSIGHT TO MEDICAID MEMBERS
, MEDICAID PROVIDERS, AND MEMBERS OF
THE PUBLIC REGARDING BEHAVIORAL HEALTH REIMBURSEMENT RATES
. THE
WEBSITE MUST INCLUDE THE FOLLOWING
:
(I) A
LL COMPLETED COST REPORTS FOR EACH BEHAVIORAL HEALTH
SAFETY NET PROVIDER
, AS DEFINED IN 27-50-101 (7);
PAGE 3-HOUSE BILL 22-1268 (II) AN OVERVIEW OF THE PURPOSE OF THE COST REPORT DESCRIBED
IN THIS SUBSECTION
(1);
(III) I
NFORMATION ON HOW TO INTERPRET THE COST REPORTS AND
WHERE TO FIND INFORMATION IN THE COST REPORTS
;
(IV) A
N OVERVIEW OF:
(A) H
OW REIMBURSEMENT RATES ARE DETERMINED ;
(B) W
HAT CONSTITUTES A REASONABLE AND ALLOWABLE COST ; AND
(C) HOW VALUE-BASED PAYMENTS IMPACT REIMBURSEMENT RATES ;
AND
(V) THE STATE DEPARTMENT 'S PLAN TO IMPROVE BEHAVIORAL
HEALTH REIMBURSEMENT RATES AND ANNUAL UPDATES TO THE PLAN
.
PAGE 4-HOUSE BILL 22-1268 SECTION 4. Safety clause. The general assembly hereby finds,
determines, and declares that this act is necessary for the immediate
preservation of the public peace, health, or safety.
____________________________ ____________________________
Alec Garnett Steve Fenberg
SPEAKER OF THE HOUSE PRESIDENT OF
OF REPRESENTATIVES THE SENATE
____________________________ ____________________________
Robin Jones Cindi L. Markwell
CHIEF CLERK OF THE HOUSE SECRETARY OF
OF REPRESENTATIVES THE SENATE
APPROVED________________________________________
(Date and Time)
_________________________________________
Jared S. Polis
GOVERNOR OF THE STATE OF COLORADO
PAGE 5-HOUSE BILL 22-1268