HB 25-1213
Fiscal Note
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
HB 25-1213: UPDATES TO MEDICAID
Prime Sponsors:
Rep. Feret
Sen. Daugherty
Published for: House Health & Human Services
Drafting number: LLS 25-0820
Fiscal Analyst:
Brendan Fung, 303-866-4781
brendan.fung@coleg.gov
Version: Initial Fiscal Note
Date: February 20, 2025
Fiscal note status: This fiscal note reflects the introduced bill.
Summary Information
Overview. The bill exempts small assisted living facilities from certain regulations and modifies the state
Medicaid program.
Types of impacts. The bill is projected to affect the following areas on an ongoing basis:
State Expenditures
Appropriations. For FY 2025-26, the bill requires an appropriation of $21,982 to the Department of Public
Health and Environment.
Table 1
State Fiscal Impacts
Type of Impact
1
Budget Year
FY 2025-26
Out Year
FY 2026-27
State Revenue $0 $0
State Expenditures $26,511 -$9,252
Transferred Funds $0 $0
Change in TABOR Refunds $0 $0
Change in State FTE 0.2 FTE -0.1 FTE
1
Fund sources for these impacts are shown in the tables below. Page 2
February 20, 2025 HB 25-1213
Table 1A
State Expenditures
Fund Source
Budget Year
FY 2025-26
Out Year
FY 2026-27
General Fund $0 $0
Cash Funds $21,982 -$7,328
Federal Funds $0 $0
Centrally Appropriated $4,529 -$1,924
Total Expenditures $26,511 -$9,252
Total FTE 0.2 FTE -0.1 FTE
Summary of Legislation
The bill exempts certain assisted living facilities from compliance standards and modifies the
state’s Medicaid program.
Assisted Living Facilities
The bill requires the Colorado Department of Public Health and Environment (CDPHE) to exempt
an assisted living facility with fewer than 19 beds that has not undergone new construction or
renovations from complying with facility guidelines.
Medicaid
The bill makes several changes to administrative, eligibility, billing, and review requirements of
the state’s Medicaid program under the Department of Health Care Policy and Financing (HCPF),
including:
directing HCPF to adopt standards set by the federal Centers for Medicare and Medicaid
Services (CMS) when updating existing rules;
requiring HCPF to establish a process to review and update the general billing manual on an
annual basis;
requiring a managed care organization (MCO) to issue payment to a contracted provider
within one year for a claim that is reprocessed after updating provider rates;
expanding contract requirements between HCPF and MCOs;
prohibiting HCPF from imposing signature requirements beyond what is required by CMS on
a physician or practitioner who is certifying a member’s plan of care that involves physical or
occupational therapy services; and
requiring HCPF to continue providing long-term care services to members if their disability
or need has not changed in the past three years. Page 3
February 20, 2025 HB 25-1213
Assumptions
CDPHE regulates assisted living facilities and promulgates rules related to sanitization, food
safety, dining services, pest control, and waste management, among others. The fiscal note
assumes that “facility guidelines,” as referenced in the bill, includes all rules and regulations
imposed by the CDPHE on these facilities. The fiscal note also assumes that these facilities would
still be licensed by the state and, therefore, maintain compliance with rules and regulations
related to patient care.
State Expenditures
The bill increases state expenditures in the Department of Public Health and Environment by
about $27,000 in FY 2025-26 and decreases expenditures by $9,000 beginning in FY 2026-27.
These costs, paid from the Assisted Living Residence Cash Fund, are summarized in Table 2 and
discussed below. The bill also affects workload in the Department of Health Care Policy and
Financing.
Table 2
State Expenditures
Department of Public Health and Environment
Cost Component
Budget Year
FY 2025-26
Out Year
FY 2026-27
Personal Services – Rulemaking $29,310 $0
Personal Services – Facility Inspections -$7,328 -$7,328
Centrally Appropriated Costs – Net $4,529 -$1,924
Total Costs $26,511 -$9,252
Total FTE – Rulemaking 0.3 FTE 0.0 FTE
Total FTE – Facility Inspections -0.1 FTE -0.1 FTE
Department Public Health and Environment
Starting in FY 2025-26, the bill impacts expenditures in the CDPHE in two ways, as shown in
Table 2 and described below.
Rulemaking
In FY 2025-26 only, the CDPHE requires 0.3 FTE Policy Analyst III to assist the Board of Health
with rule modification and conduct outreach to exempted facilities. The department may require
legal services, provided by the Department of Law, related to rulemaking and implementation,
which can be accomplished within existing appropriations. Page 4
February 20, 2025 HB 25-1213
Facility Inspections
Currently, the CDPHE conducts routine surveys on assisted living facilities every three years.
Eliminating inspections for an estimated 400 exempted facilities decreases department
expenditures by 0.1 FTE Health Professional III starting in FY 2025-26.
Department of Health Care Policy and Financing
Workload in HCPF will minimally increase to update rules, publish medical loss ratio data, and
implement certain provisions in the bill. However, various fiscal impacts are indeterminate and
may increase expenditures on an ongoing basis. See Technical Note.
Centrally Appropriated Costs
Pursuant to a Joint Budget Committee policy, certain costs associated with this bill are
addressed through the annual budget process and centrally appropriated in the Long Bill or
supplemental appropriations bills, rather than in this bill. These costs, which may include
employee insurance, supplemental employee retirement payments, leased space, and indirect
cost assessments, are shown in the expenditure table above.
Technical Note
The fiscal note cannot estimate the impact of several provisions which are either unclear or
potentially conflict with federal law. Specifically, the bill does not specify which CMS standards
HCPF must adopt when updating rules and does not define which "necessary CPT codes" must
be reviewed and updated annually or if this requires an evaluation of all codes. Thus, the impact
of these provisions is indeterminate. In addition, the bill requires HCPF to continue providing
long-term care services for three years if there is no change in disability or service needs, which
conflicts with federal regulations requiring annual reevaluation, among other things. Thus, the
fiscal note assumes this provision will not be implemented in order to ensure ongoing federal
financial participation for the state Medicaid program.
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 2025-26, the bill requires an appropriation of $21,982 from the Assisted Living Residence
Cash Fund to the Department of Public Health and Environment, and 0.3 FTE. Page 5
February 20, 2025 HB 25-1213
State and Local Government Contacts
Health Care Policy and Financing
Law
Public Health and Environment
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 the General Assembly website.