First Regular Session
Seventy-fifth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 25-0820.01 Chelsea Princell x4335
HOUSE BILL 25-1213
House Committees Senate Committees
Health & Human Services
A BILL FOR AN ACT
C
ONCERNING CHANGES TO THE MEDICAL ASSISTANCE PROGRAM .101
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 exempts an assisted living residence with fewer than 19
beds that has not undergone new construction or renovations and that
complies with the standards for assisted living residences from complying
with facility guidelines adopted by the state board of health.
The bill requires the department of health care policy and
financing (state department) to follow the standards set by the federal
centers for medicare and medicaid when updating rules.
The state department must establish a process for reviewing and
HOUSE SPONSORSHIP
Feret,
SENATE SPONSORSHIP
Daugherty,
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. updating the general billing manual on an annual basis and ensure that the
general billing manual includes all necessary CPT codes.
Beginning January 1, 2026, for claims that must be reprocessed as
a result of updating the provider rates, the bill requires a managed care
organization to issue payment to a contracted provider within one year
after the provider rate is updated.
The bill requires the state department to include in each new
contract with, or renewal of a contract with, a managed care entity (MCE)
a provision requiring the MCE to submit to the state department, on an
annual basis, the amount the MCE is paid and the MCE's medical loss
ratio. The state department is required to publish this information on the
state department's website on an annual basis.
The bill prohibits the state department from imposing signature
requirements on a physician or practitioner certifying a medicaid
member's (member) plan of care that involves physical therapy or
occupational therapy.
The bill prevents a member receiving home- and community-based
services from losing the services the member currently receives if the
member's disability and need for services have not changed in the
preceding 3 years.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, 25-27-104, add (3)2
as follows:3
25-27-104. Minimum standards for assisted living residences4
- rules. (3) R
ULES ADOPTED BY THE STATE BOARD PURSUANT TO5
SUBSECTION (1) OF THIS SECTION MUST EXEMPT AN ASSISTED LIVING6
RESIDENCE WITH FEWER THAN NINETEEN BEDS THAT HAS NOT UNDERGONE7
NEW CONSTRUCTION OR RENOVATIONS AND THAT COMPLIES WITH THE8
STANDARDS FOR ASSISTED LIVING RESIDENCES OUTLINED IN SECTION9
25-27-104
FROM COMPLYING WITH FACILITY GUIDELINES ADOPTED BY THE10
STATE BOARD.11
SECTION 2. In Colorado Revised Statutes, 25.5-1-108, add (1.5)12
as follows:13
25.5-1-108. Executive director - rules. (1.5) T
HE EXECUTIVE14
HB25-1213-2- DIRECTOR SHALL ADOPT THE STANDARDS SET BY THE FEDERAL CENTERS1
FOR MEDICARE AND MEDICAID SERVICES WHEN UPDATING EXISTING RULES2
AND ENSURE UPDATES AND CHANGES TO THE RULES ARE EASILY3
IDENTIFIABLE.4
SECTION 3. In Colorado Revised Statutes, add 25.5-1-135 as5
follows:6
25.5-1-135. Billing manual. U
SING EXISTING RESOURCES7
ALLOCATED FOR BILLING MANUAL REVIEWS , THE STATE DEPARTMENT8
SHALL ESTABLISH A PROCESS TO REVIEW AND UPDATE THE GENERAL9
BILLING MANUAL ON AN ANNUAL BASIS , WHICH MUST ENSURE THAT THE10
GENERAL BILLING MANUAL INCLUDES ALL NECESSARY CPT CODES.11
SECTION 4. In Colorado Revised Statutes, 25.5-1-303, add (10)12
as follows:13
25.5-1-303. Powers and duties of the board - scope of authority14
- rules - repeal. (10) T
HE BOARD SHALL ADOPT THE STANDARDS SET BY15
THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES WHEN16
UPDATING EXISTING RULES AND ENSURE UPDATES AND CHANGES TO THE17
RULES ARE EASILY IDENTIFIABLE.18
SECTION 5. In Colorado Revised Statutes, 25.5-5-402, add19
(7.5)(c) as follows:20
25.5-5-402. Statewide managed care system - rules -21
definitions. (7.5) (c) B
EGINNING JANUARY 1, 2026, FOR A CLAIM THAT22
MUST BE REPROCESSED AS A RESULT OF UPDATING THE PROVIDER RATES ,23
AN MCO SHALL ISSUE PAYMENT TO THE CONTRACTED PROVIDER WITHIN24
ONE YEAR AFTER THE PROVIDER RATE IS UPDATED .25
SECTION 6. In Colorado Revised Statutes, add 25.5-5-427 as26
follows:27
HB25-1213
-3- 25.5-5-427. Managed care entities - disclosure of payment and1
medical loss ratio - definition. (1) T
HE STATE DEPARTMENT SHALL2
INCLUDE IN EACH NEW CONTRACT WITH , OR RENEWAL OF A CONTRACT3
WITH, AN MCE A PROVISION REQUIRING THE MCE TO SUBMIT TO THE4
STATE DEPARTMENT, ON AN ANNUAL BASIS, THE AMOUNT THE MCE IS5
PAID FOR DELIVERING SERVICES AND THE MCE'S MEDICAL LOSS RATIO.6
(2) T
HE STATE DEPARTMENT SHALL PUBLISH THE INFORMATION7
RECEIVED PURSUANT TO SUBSECTION (1) OF THIS SECTION ON ITS WEBSITE8
ON AN ANNUAL BASIS.9
(3) F
OR PURPOSES OF SUBSECTION (1) OF THIS SECTION, "MEDICAL10
LOSS RATIO" MEANS THE PERCENTAGE OF PREMIUM REVENUE THAT THE11
MCE
SPENDS ON HEALTH-CARE SERVICES AND QUALITY IMPROVEMENT12
ACTIVITIES.13
SECTION 7. In Colorado Revised Statutes, add 25.5-6-117 as14
follows:15
25.5-6-117. Plan of care - physical therapy and occupational16
therapy - requirements - definition. (1) A
S USED IN THE SECTION,17
UNLESS THE CONTEXT OTHERWISE REQUIRES , "PLAN OF CARE" HAS THE18
SAME MEANING AS SET FORTH IN SECTION 25.5-6-403.19
(2) T
HE STATE DEPARTMENT SHALL NOT IMPOSE SIGNATURE20
REQUIREMENTS BEYOND WHAT IS REQUIRED BY THE FEDERAL CENTERS FOR21
MEDICARE AND MEDICAID SERVICES PURS UANT TO 42 CFR 409.43 ON A22
PHYSICIAN OR PRACTITIONER CERTIFYING A MEMBER 'S PLAN OF CARE THAT23
INVOLVES PHYSICAL THERAPY OR OCCUPATIONAL THERAPY SERVICES .24
SECTION 8. In Colorado Revised Statutes, add 25.5-6-118 as25
follows:26
25.5-6-118. Long-term care for members with permanent27
HB25-1213
-4- disability. (1) I F A MEMBER RECEIVES SERVICES THROUGH A LONG -TERM1
CARE PROGRAM PURSUANT TO PARTS 3 TO 10 OF THIS ARTICLE 6 AND THE2
MEMBER'S DISABILITY OR NEED FOR SERVICES HAS NOT CHANGED IN THE3
PRECEDING THREE YEARS, THE STATE DEPARTMENT MUST CONTINUE TO4
PROVIDE THE SERVICES THE MEMBER CURRENTLY RECEIVES AND IS5
ELIGIBLE FOR TO THE MEMBER UNLESS THERE IS A CHANGE IN THE6
MEMBER'S DISABILITY OR THE SERVICES THE MEMBER CURRENTLY7
RECEIVES ARE NO LONGER NEEDED. THIS SUBSECTION (1) APPLIES EVEN IF8
THE STATE DEPARTMENT DISCONTINUES THOSE SERVICES FOR A NEWLY9
ELIGIBLE MEMBER.10
(2) T
HIS SECTION DOES NOT LIMIT THE STATE DEPARTMENT 'S11
ABILITY TO INCREASE OR DECREASE THE SERVICES THE MEMBER MAY12
RECEIVE IF A MEMBER'S DISABILITY WARRANTS AN INCREASE OR DECREASE13
IN SERVICES TO ADEQUATELY MEET THE MEMBER 'S NEEDS.14
(3) T
HIS SECTION APPLIES TO MEMBERS WHO ARE FUNCTIONALLY15
AND FINANCIALLY ELIGIBLE TO RECEIVE LONG -TERM CARE SERVICES16
PURSUANT TO PARTS 3 TO 10 OF THIS ARTICLE 6.17
SECTION 9. Act subject to petition - effective date. This act18
takes effect at 12:01 a.m. on the day following the expiration of the19
ninety-day period after final adjournment of the general assembly; except20
that, if a referendum petition is filed pursuant to section 1 (3) of article V21
of the state constitution against this act or an item, section, or part of this22
act within such period, then the act, item, section, or part will not take23
effect unless approved by the people at the general election to be held in24
November 2026 and, in such case, will take effect on the date of the25
official declaration of the vote thereon by the governor.26
HB25-1213
-5-