First Regular Session Seventy-fourth General Assembly STATE OF COLORADO REREVISED This Version Includes All Amendments Adopted in the Second House LLS NO. 23-0700.01 Shelby Ross x4510 HOUSE BILL 23-1228 House Committees Senate Committees Public & Behavioral Health & Human Services Appropriations Finance Appropriations A BILL FOR AN ACT C ONCERNING NURSING FACILITY REIMBURSEMENT RATE SETTING, AND,101 IN CONNECTION THEREWITH , MAKING AN APPROPRIATION .102 Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill 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 .) The bill adjusts the supplemental medicaid payment rates a qualifying nursing facility receives from the department of health care policy and financing (state department). Current law limits the annual increase of the general fund share of the aggregate statewide average of the per diem rate to not more than 3%. The bill removes this limitation and requires the general fund share be SENATE 3rd Reading Unamended April 24, 2023 SENATE 2nd Reading Unamended April 21, 2023 HOUSE 3rd Reading Unamended April 15, 2023 HOUSE Amended 2nd Reading April 14, 2023 HOUSE SPONSORSHIP McCluskie and Willford, Amabile, Bird, Boesenecker, Brown, Daugherty, Dickson, Duran, Frizell, Froelich, Hamrick, Herod, Jodeh, Joseph, Lieder, Lindstedt, Marshall, Martinez, McCormick, Michaelson Jenet, Sharbini, Sirota, Snyder, Titone, Valdez, Velasco, Woodrow, Young SENATE SPONSORSHIP Zenzinger and Smallwood, Bridges, Buckner, Cutter, Exum, Ginal, Hansen, Marchman, Mullica, Pelton B., Pelton R., Will Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment. 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. calculated based on specific percentage increases. The bill requires the state department to initiate a process no later than July 1, 2023, to remove the medicare costs from the provider rate setting by July 1, 2026. The bill repeals the requirement that only such costs as are reasonable, necessary, and patient-related be reported for reimbursement purposes. The bill authorizes the state department to require a nursing facility, as a condition of receiving medicaid funds, to submit any documentation necessary to ensure the state's interest in transparency, stability, and sound fiscal stewardship. As part of developing and implementing a transition plan to regulate nursing facility reimbursement, the bill requires the state department to: ! No later than July 1, 2026, define "nursing home reimbursement" and provide payments to nursing facilities; ! Engage with stakeholders regularly to seek input on any proposed methodology changes; and ! From November 1, 2023, to November 1, 2026, submit an annual report to the joint budget committee of the general assembly regarding the implementation process. The bill requires the state department to issue additional supplemental payments to nursing facility providers with disproportionately high medicaid utilization, to facilities that are geographically critical to ensuring access to care, and to facilities that admit compassionate release individuals from the department of corrections. Effective July 1, 2026, the bill repeals: ! The requirement that the state department exempt certain nursing facility providers from the provider fee; ! The process for providing a wage enhancement supplemental payment to eligible nursing home providers that pay their employees a wage of at least $15 per hour; and ! Requirements for issuing additional supplemental payments to nursing facility providers that meet certain requirements. Be it enacted by the General Assembly of the State of Colorado:1 SECTION 1. In Colorado Revised Statutes, 25.5-6-202, amend2 (5), (6), (9)(b)(I), and (9)(c)(I); repeal (9)(c)(II); and add (9)(b)(I.5),3 (13), (14), (15), and (16) as follows:4 1228-2- 25.5-6-202. Providers - nursing facility provider1 reimbursement - exemption - rules - repeal. (5) Subject to available2 moneys APPROPRIATIONS and the priority of the uses of the provider fees3 as established in section 25.5-6-203 (2)(b), in addition to the4 reimbursement rate components paid pursuant to subsections (1) to (4) of5 this section, the state department shall make a supplemental medicaid6 payment based upon performance to those nursing facility providers that7 provide services that result in better care and higher quality of life for8 their residents. This amount shall be determined by The state department9 SHALL DETERMINE THE PAYMENT AMOUNT based upon performance10 measures established in rules adopted by the state board in the domains11 of quality of life, quality of care, and facility management. The payment12 shall be computed annually as of July 1, 2009, and each July 1 thereafter,13 and shall not be less than twenty-five hundredths of one percent of the14 statewide average per diem rate for the combined rate components15 determined pursuant to subsections (1) to (4) of this section. BEGINNING16 J ULY 1, 2024, THE PAYMENT MUST NOT BE LESS THAN TWELVE PERCENT OF17 TOTAL PROVIDER FEE PAYMENTS AND MUST BE ADJUSTED FOR FISCAL18 YEARS 2024-25 AND 2025-26. NO LATER THAN JULY 1, 2026, THE19 PAYMENT MUST NOT BE LESS THAN FIFTEEN PERCENT OF TOTAL PROVIDER20 FEE PAYMENTS AND MUST BE ANNUALLY ADJUSTED THEREAFTER. During21 each state fiscal year, the state department may discontinue the22 supplemental medicaid payment established pursuant to this subsection23 (5) to any nursing facility provider that fails to comply with the24 established performance measures during the state fiscal year, and the25 state department may initiate the supplemental medicaid payment26 established pursuant to this subsection (5) to any provider who THAT27 1228 -3- comes into compliance with the established performance measures during1 the state fiscal year.2 (6) Subject to available money APPROPRIATIONS and the priority3 of the uses of the provider fees as established in section 25.5-6-2034 (2)(b), in addition to the reimbursement rate components PAID pursuant5 to subsections (1) to (5) of this section, the state department shall make6 a supplemental medicaid payment to nursing facility providers that have 7 SERVE residents: who have moderately to very severe mental health8 conditions, dementia diseases and related disabilities, or acquired brain9 injury as follows:10 (a) A supplemental medicaid payment shall be made to nursing11 facility providers that serve residents Who have severe mental health12 conditions that are classified at a level II by the medicaid program's13 preadmission screening and resident review assessment tool. The state14 department shall compute this payment annually as of July 1, 2009, and15 each July 1 thereafter, and it shall be MUST not BE less than two percent16 of the statewide average per diem rate for the combined rate components17 determined pursuant to subsections (1) to (4) of this section. B EGINNING18 J ULY 1, 2023, THE STATE DEPARTMENT SHALL ANNUALLY ADJUST THE19 RATE TO ENSURE ACCESS TO CARE FOR RESIDENTS WHO HAVE SEVERE20 MENTAL HEALTH CONDITIONS .21 (b) A supplemental medicaid payment shall be made to nursing 22 facility providers that serve residents With severe dementia diseases and23 related disabilities or acquired brain injury. The state department shall24 calculate the payment based upon the resident's cognitive assessment25 established in rules adopted by the state board. The state department shall26 compute this payment annually as of July 1, 2009, and each July 127 1228 -4- thereafter, and it shall be MUST not BE less than one percent of the1 statewide average per diem rate for the combined rate components2 determined under PURSUANT TO subsections (1) to (4) of this section.3 B EGINNING JULY 1, 2023, THE STATE DEPARTMENT SHALL ANNUALLY4 ADJUST THE RATE TO ENSURE ACCESS TO CARE FOR RESIDENTS WITH5 SEVERE DEMENTIA DISEASES AND RELATED DISABILITIES OR ACQUIRED6 BRAIN INJURY.7 (9) (b) (I) Except for changes in the number of patient days, THE8 STATE DEPARTMENT SHALL ESTABLISH the general fund share of the9 aggregate statewide average of the per diem rate net of patient payment10 pursuant to subsections (1) to (4) of this section. shall be limited to an 11 annual increase of three percent The state's share of the reimbursement12 rate components pursuant to subsections (1) to (4) of this section may be13 funded through the provider fee assessed pursuant to the provisions of14 section 25.5-6-203 and any associated federal funds. Any provider fee15 used as the state's share and all federal funds shall MUST be excluded from16 the calculation of the general fund limitation on the annual increase17 SHARE. For the fiscal year commencing July 1, 2009, and for each fiscal18 year thereafter, THE STATE DEPARTMENT SHALL CALCULATE the general19 fund share of the aggregate statewide average per diem rate net of patient20 payment pursuant to subsections (1) to (4) of this section shall be 21 calculated using the rates that were effective on July 1 of that fiscal year;22 EXCEPT THAT:23 (A) F OR FISCAL YEAR 2023-24, THE STATE DEPARTMENT SHALL24 INCREASE THE AGGREGATE STATEWIDE AVERAGE OF THE PER DIEM RATE25 BY AT LEAST TEN PERCENT;26 (B) F OR FISCAL YEAR 2024-25, THE STATE DEPARTMENT SHALL27 1228 -5- INCREASE THE AGGREGATE STATEWIDE AVERAGE OF THE PER DIEM RATE1 BY AT LEAST THREE PERCENT;2 (C) F OR FISCAL YEAR 2025-26, THE STATE DEPARTMENT SHALL3 INCREASE THE AGGREGATE STATEWIDE AVERAGE OF THE PER DIEM RATE4 BY AT LEAST ONE AND ONE-HALF PERCENT; AND5 (D) B EGINNING IN FISCAL YEAR 2026-27, AND FOR EACH FISCAL6 YEAR THEREAFTER, THE STATE DEPARTMENT SHALL ESTABLISH THE7 AGGREGATE STATEWIDE AVERAGE OF THE PER DIEM RATE .8 (I.5) W HEN INCREASING THE AGGREGATE STATEWIDE AVERAGE OF9 THE PER DIEM RATE FOR FISCAL YEARS 2023 THROUGH 2027, THE10 REIMBURSEMENT RATE FOR A CLASS I NURSING FACILITY THAT OPERATES11 EFFICIENTLY AND ECONOMICALLY MUST BE REASONABLE AND ADEQUATE12 TO MEET THE NURSING HOME 'S COSTS IN ORDER TO PROVIDE CARE AND13 SERVICES IN CONFORMITY WITH APPLICABLE STATE AND FEDERAL LAWS ,14 REGULATIONS, AND QUALITY AND SAFETY STANDARDS , AND MUST BE15 BASED ON THE MOST RECENT AUDITED AND FINALIZED COST AND16 UTILIZATION DATA AVAILABLE.17 (c) (I) The general assembly finds that the historical growth in18 nursing facility provider rates has significantly exceeded the rate of19 inflation. These increases have been caused in part by the inclusion of20 medicare costs in medicaid cost reports. The state of Colorado has an21 interest in limiting these exceptional increases in medicaid nursing facility22 provider rates by removing medicare part B direct costs from the23 medicaid nursing facility provider rates and by imposing a ceiling on the24 medicare part A ancillary costs that are included in calculating medicaid25 nursing facility rates. N O LATER THAN JULY 1, 2023, THE STATE26 DEPARTMENT SHALL INITIATE A PROCESS TO REMOVE MEDICARE COSTS27 1228 -6- FROM THE PROVIDER RATE SETTING BY JULY 1, 2026. THE STATE BOARD1 SHALL PROMULGATE RULES ESTABLISHING THE SPECIFIC METHODOLOGY2 USED FOR REMOVING MEDICARE COSTS .3 (II) For all rates effective on or after July 1, 1997, for each class4 I nursing facility provider, only such costs as are reasonable, necessary,5 and patient-related may be reported for reimbursement purposes. Nursing6 facility providers may include the level of medicare part A ancillary costs7 that was included and allowed in the facility's last medicaid cost report8 filed prior to July 1, 1997. Any subsequent increase in this amount shall9 be limited to either the increase in the facility's allowable medicare part10 A ancillary costs or the percentage increase in the cost of medical care11 reported in the United States department of labor bureau of labor statistics12 consumer price index for the same time period, whichever is lower. Part13 B direct costs for medicare shall be excluded from the allowable14 reimbursement for facilities.15 (13) (a) A S A CONDITION OF RECEIVING MEDICAID FUNDS , THE16 STATE DEPARTMENT MAY REQUIRE A NURSING FACILITY TO SUBMIT ANY17 DOCUMENTATION NECESSARY TO ENSURE THE STATE 'S INTEREST IN18 TRANSPARENCY, STABILITY, AND SOUND FISCAL STEWARDSHIP ,19 INCLUDING, BUT NOT LIMITED TO:20 (I) A NNUAL AUDITED FINANCIAL STATEMENTS , PREPARED BY AN21 INDEPENDENT ACCOUNTANT , FOR A FACILITY, MANAGEMENT COMPANY ,22 AND ANY RELATED PARTY C ONDUCTING BUSINESS WITH A23 MEDICAID-CERTIFIED NURSING FACILITY , INCLUDING AUDITED AND24 CONSOLIDATED FINANCIAL STATEMENTS FOR ANY PARENT COMPANY THAT25 ACCEPTS, OR WHOSE SUBSIDIARIES ACCEPT, MEDICAID PAYMENTS FROM26 THE STATE OF COLORADO;27 1228 -7- (II) DETAILS ON TRANSACTIONS BETWEEN RELATED PARTIES OR1 ENTITIES THAT HAVE COMMON OWNERSHIP ; AND2 (III) O WNERSHIP INTEREST IN REAL ESTATE , MANAGEMENT3 COMPANIES, FACILITY OPERATORS, AND ALL RELATED PARTIES.4 (b) T HE STATE DEPARTMENT SHALL DETERMINE THE FORMAT FOR5 THE DOCUMENTATION PROVIDED BY EACH NURSING FACILITY .6 (c) T HE STATE BOARD SHALL ESTABLISH BY RULE ANY PENALTIES7 FOR NONCOMPLIANCE WITH THE FINANCIAL REPORTING REQUIRED8 PURSUANT TO THIS SUBSECTION (13).9 (d) T HE COSTS ASSOCIATED WITH THE FINANCIAL REPORTING10 REQUIRED PURSUANT TO THIS SUBSECTION (13), INCLUDING ANY AUDIT11 COSTS INCURRED BY A NURSING FACILITY , ARE AN ALLOWABLE EXPENSE12 ON THE MEDICAID COST REPORT AND MUST BE INCORPORATED AS A13 COMPONENT OF THE OVERALL REIMBURSEMENT METHODOLOGY .14 (14) T HE GENERAL ASSEMBLY FINDS THAT THE INFLEXIBLE15 NATURE OF STATUTORILY FIXED REIMBURSEMENT RATES IS NOT IN THE16 BEST INTEREST OF THE STATE OF COLORADO. THEREFORE, THE STATE17 DEPARTMENT SHALL DEVELOP AND IMPLEMENT A TRANSITION PLAN TO18 REGULATE NURSING FACILITY REIMBURSEMENT AIMED AT IMPROVING THE19 HEALTH AND SAFETY OF RESIDENTS , PROMOTING INNOVATION AND20 IMPROVED INFECTION CONTROL EFFORTS , IMPROVING ACCESS TO CARE,21 AND PROMOTING INNOVATION IN COLORADO NURSING FACILITIES. AS PART22 OF THIS PROCESS, THE STATE DEPARTMENT SHALL :23 (a) N O LATER THAN JULY 1, 2026, DEFINE "NURSING HOME24 REIMBURSEMENT" THROUGH RULES PROMULGATED BY THE STATE BOARD25 AND PROVIDE PAYMENTS TO NURSING FACILITIES CONSISTENT WITH THE26 PROMULGATED RULES;27 1228 -8- (b) ENGAGE WITH STAKEHOLDERS REGULARLY TO SEEK INPUT ON1 ANY PROPOSED METHODOLOGY CHANGES AND ENSURE THE METHODOLOGY2 IS REASONABLE AND ADEQUATE TO MEET THE COSTS OF AN EFFICIENTLY3 AND ECONOMICALLY OPERATED NURSING FACILITY THAT PROVIDES CARE4 AND SERVICES IN CONFORMITY WITH APPLICABLE STATE AND FEDERAL5 LAWS, REGULATIONS, AND QUALITY AND SAFETY STANDARDS BASED ON6 THE MOST RECENT AUDIT AND FINALIZED COST AND UTILIZATION DATA7 AVAILABLE; AND8 (c) F ROM NOVEMBER 1, 2023, TO NOVEMBER 1, 2026, SUBMIT AN9 ANNUAL REPORT TO THE JOINT B UDGET COMMITTEE OF THE GENERAL10 ASSEMBLY REGARDING THE IMPLEMENTATION PROGRESS DESCRIBED IN11 THIS SUBSECTION (14), INCLUDING, AT A MINIMUM:12 (I) R ECORDS OF STAKEHOLDER ENGAGEMENT ;13 (II) C ONCLUSIONS DRAWN FROM FINANCIAL OVERSIGHT14 ACTIVITIES;15 (III) I SSUES REGARDING PAYMENT EQUITY AND ACCESS TO CARE16 COORDINATION; AND17 (IV) E XPECTED BUDGETARY IMPACTS OF ANY METHODOLOGY18 CHANGE.19 (15) (a) EACH NURSING FACILITY THAT RECEIVES MEDICAID FUNDS20 SHALL DEVELOP AND SUBMIT A PLAN TO THE STATE DEPARTMENT THAT21 MEETS STATE DEPARTMENT STANDARDS AND DEMONSTRATES HOW THE22 NURSING FACILITY WILL:23 (I) IMPROVE THE HEALTH AND SAFETY OF THE NURSING FACILITY'S24 RESIDENTS, INCLUDING INFECTION CONTROL AND STAFFING ;25 (II) INCREASE ACCESS TO CARE;26 (III) IMPROVE FINANCIAL SUSTAINABILITY, INCLUDING27 1228 -9- OPPORTUNITIES FOR DIVERSIFICATION OF BUSINESS LINES AND1 STABILIZATION OF REVENUE STREAMS ; AND2 (IV) PROMOTE INNOVATION TO MEET THE EMERGING NEEDS OF3 INDIVIDUALS WITH DISABILITIES AND AGING AND OLDER ADULTS .4 (b) THE STATE BOARD SHALL PROMULGATE RULES IMPLEMENTING5 THIS SUBSECTION (15).6 (16) SUBSECTIONS 1 TO 9 OF THIS SECTION AND THIS SUBSECTION7 (16) ARE REPEALED, EFFECTIVE JULY 1, 2026.8 SECTION 2. In Colorado Revised Statutes, 25.5-6-203, amend9 (1)(c) as follows:10 25.5-6-203. Nursing facilities - provider fees - federal waiver11 - fund created - rules - repeal. (1) (c) (I) In accordance with the12 redistributive method set forth in 42 CFR 433.68 (e)(1) and (e)(2), the13 state department shall seek a waiver from the broad-based provider fees14 requirement or the uniform provider fees requirement, or both, to exclude15 nursing facility providers from the provider fee. The state department16 shall exempt the following nursing facility providers to obtain federal17 approval and minimize the financial impact on nursing facility providers:18 (I) (A) A facility operated as a continuing care retirement19 community that provides a continuum of services by one operational20 entity providing independent living services, assisted living services, and21 skilled nursing care on a single, contiguous campus. Assisted living22 services include an assisted living residence as defined in section23 25-27-102 C.R.S., or that provides assisted living services on-site,24 twenty-four hours per day, seven days per week.25 (II) (B) A skilled nursing facility owned and operated by the state;26 (III) (C) A nursing facility that is a distinct part of a facility that27 1228 -10- is licensed as a general acute care hospital; and1 (IV) (D) A facility that has forty-five or fewer licensed beds.2 (II) NO LATER THAN JULY 1, 2026, THE STATE DEPARTMENT SHALL3 PROMULGATE RULES MAINTAINING THE EXEMPTIONS IDENTIFIED IN THIS4 SUBSECTION (1)(c) IN ORDER TO MINIMIZE THE FINANCIAL IMPACT ON5 NURSING FACILITY PROVIDERS.6 (III) THIS SUBSECTION (1)(c) IS REPEALED, EFFECTIVE JULY 1,7 2028.8 SECTION 3. In Colorado Revised Statutes, 25.5-6-208, add (7)9 as follows:10 25.5-6-208. Nursing facility provider reimbursement - rules -11 definition - repeal. (7) T HIS SECTION IS REPEALED, EFFECTIVE JULY 1,12 2026.13 SECTION 4. In Colorado Revised Statutes, 25.5-6-210, amend14 (10); repeal (1)(a), (1)(b), (6), (7), (8), and (9); and add (1)(c) and (1)(d)15 as follows:16 25.5-6-210. Additional supplemental payments - nursing17 facilities - funding methodology - reporting requirement - rules -18 repeal. (1) Notwithstanding any other provision of law to the contrary19 and subject to available appropriations, for the purposes of reimbursing20 a medicaid-certified class I nursing facility provider, the state department21 shall issue additional supplemental payments to nursing facility providers22 that meet the requirements outlined in this section and the state23 department's subsequent regulation as follows:24 (a) For the 2021-22 state fiscal year, funds appropriated by the 25 general assembly are for the purposes of supporting nursing facility26 providers experiencing increased staffing costs resulting from the27 1228 -11- COVID-19 pandemic, nursing facility providers with high medicaid1 utilization rates, or nursing facility providers currently serving individuals2 with complex needs.3 (b) Payments made in addition to those specified in subsection4 (1)(a) of this section may also be made to nursing facility providers that5 accept new admissions of medicaid-enrollment individuals with complex6 needs.7 (c) A PAYMENT TO A NURSING FACILITY WITH8 DISPROPORTIONATELY HIGH MEDICAID UTILIZATION OR GEOGRAPHICALLY9 CRITICAL TO ENSURING ACCESS TO CARE . IN DETERMINING QUALIFYING10 FACILITIES FOR THIS PAYMENT, THE STATE DEPARTMENT SHALL CONSIDER11 ANY ACCESS TO CARE IMPACTS TO INDIVIDUALS NOT COVERED BY12 MEDICAID, INCLUDING, BUT NOT LIMITED TO, VETERANS ADMINISTRATION13 BENEFICIARIES, INDIVIDUALS WITHOUT HEALTH -CARE COVERAGE, AND14 INDIVIDUALS PENDING MEDICAID COVERAGE .15 (d) A PAYMENT TO A NURSING FACILITY ADMITTING16 COMPASSIONATE RELEASE INDIVIDUALS FROM THE DEPARTMENT OF17 CORRECTIONS WHO NEED ADDITIONAL SERVICES TO ENSURE ACCESS TO18 CARE.19 (6) To receive an additional payment pursuant to subsection (1)(b) 20 of this section, a nursing facility provider shall work with a hospital to21 facilitate the timely discharge of medicaid members from the hospital into22 the nursing facility, serve medicaid members with complex needs, or23 accept compassionate release individuals from the department of24 corrections.25 (7) On or before November 1, 2022, the state department shall26 engage with stakeholders and submit a report and recommendations to the27 1228 -12- joint budget committee, the health and human services committee of the1 senate, and the public and behavioral health and human services2 committee of the house of representatives, or any successor committees,3 concerning suggested changes for permanently changing medicaid4 nursing facility provider reimbursement policy in Colorado to prioritize5 quality, sustainability, and sound fiscal stewardship to avoid further6 one-time cash infusions. The report must include changes that can be7 made to affirm a nursing facility provider's commitment to accountability8 and must include, at a minimum:9 (a) Infection control and culture change practices, including:10 (I) Single occupancy rooms;11 (II) Smaller facility models; and12 (III) Innovative facility models;13 (b) Behavioral health needs;14 (c) Practices regarding individuals who have complex needs15 requiring hospital discharge;16 (d) Practices regarding care and services to compassionate release17 individuals from the department of corrections;18 (e) Options for diversified funding streams to ensure continuity of19 services;20 (f) Competitive staffing practices;21 (g) The timeline and costs associated with implementing the22 recommended changes, including the impact on nursing facility provider23 rates; and24 (h) Identification of the amount of supplemental payments to each25 nursing facility provider and the outcome evaluation required pursuant to26 subsection (3) of this section.27 1228 -13- (8) The state department shall meet with the following1 stakeholders, at a minimum, to seek input on any proposed reimbursement2 methodology changes and report as required by this section:3 (a) A representative from an urban nursing facility provider;4 (b) A representative from a rural nursing facility provider;5 (c) A representative from a nursing facility trade organization;6 (d) A representative from a nursing facility with a high medicaid7 utilization rate; and8 (e) A representative from a nursing facility that serves individuals9 with complex needs.10 (9) The state board shall promulgate any rules necessary to11 implement this section.12 (10) This section is repealed, effective July 1, 2023 2026.13 SECTION 5. In Colorado Revised Statutes, 25-48-102, amend14 (4) as follows:15 25-48-102. Definitions. As used in this article 48, unless the16 context otherwise requires:17 (4) "Health-care provider" or "provider" means a person who is18 licensed, certified, registered, or otherwise authorized or permitted by law19 to administer health care or dispense medication in the ordinary course of20 business or practice of a profession. The term includes a health-care21 facility, including a long-term care facility as defined in section22 25-3-103.7 (1)(f.3) and a continuing care retirement community as23 described in section 25.5-6-203 (1)(c)(I), C.R.S. (1)(c)(I)(A).24 SECTION 6. Appropriation. (1) For the 2023-24 state fiscal25 year, $30,509,457 is appropriated to the department of health care policy26 and financing. This appropriation is from the general fund, which is27 1228 -14- subject to the "(M)" notation as defined in the annual general1 appropriation act for the same fiscal year. To implement this act, the2 department may use this appropriation for medical and long-term care3 services for Medicaid eligible individuals.4 (2) For the 2023-24 state fiscal year, the general assembly5 anticipates that the department of health care policy and financing will6 receive $31,754,740 in federal funds for medical and long-term care7 services for Medicaid eligible individuals to implement this act. The8 appropriation in subsection (1) of this section is based on the assumption9 that the department will receive this amount of federal funds.10 SECTION 7. Safety clause. The general assembly hereby finds,11 determines, and declares that this act is necessary for the immediate12 preservation of the public peace, health, or safety.13 1228 -15-