First Regular Session
Seventy-fifth General Assembly
STATE OF COLORADO
REENGROSSED
This Version Includes All Amendments
Adopted in the House of Introduction
LLS NO. 25-0820.01 Chelsea Princell x4335
HOUSE BILL 25-1213
House Committees Senate Committees
Health & Human Services
Appropriations
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
3rd Reading Unamended
March 26, 2025
HOUSE
Amended 2nd Reading
March 25, 2025
HOUSE SPONSORSHIP
Feret and Weinberg, Bacon, Bird, Boesenecker, Duran, English, Garcia, Gonzalez R.,
Jackson, Joseph, Lieder, Lindstedt, McCluskie, Ricks, Stewart K., Stewart R., Titone
SENATE SPONSORSHIP
Daugherty and Ball,
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 - definition. (3) (a) RULES ADOPTED BY THE STATE BOARD5
PURSUANT TO SUBSECTION (1) OF THIS SECTION MUST EXEMPT AN6
ASSISTED LIVING RESIDENCE WITH FE WER THAN NINETEEN BEDS FROM7
COMPLYING WITH THE FACILITY GUIDELINE INSTITUTE (FGI) GUIDELINES,8
EXCEPT IN THE CASE OF NEW CONSTRUCTION OR MAJOR RENOVATIONS. AN9
ASSISTED LIVING RESIDENCE WITH FE WER THAN NINETEEN BEDS MUST10
STILL COMPLY WITH ALL OTHER FIRE AND LOCAL BUILDING CODES AND THE11
STANDARDS OUTLINED IN THIS SECTION .12
(b) FOR PURPOSES OF SUBSECTION (3)(a) OF THIS SECTION, "MAJOR13
RENOVATIONS" MEANS ADDITIONS TO A BUILDING'S STRUCTURE OR14
1213-2- CHANGES THAT AFFECT THE STRUCTURAL INTEGRITY OF THE BUILDING .1
MAJOR RENOVATIONS DO NOT INCLUDE CHANGING THE FUNCTIONAL2
OPERATION OF A SPACE IF NO CONSTRUCTION IS COMPLETED AND THE3
FLOOR PLAN OF THE BUILDING REMAINS THE SAME . IT ALSO DOES NOT4
INCLUDE ADDING BEDS TO ACCOMMODATE MORE RESIDENTS OR UPGRADES5
TO THE HEATING OR COOLING SYSTEMS AND ELECTRICAL SYSTEMS IF6
THOSE IMPROVEMENTS DO NOT REQUIRE CONSTRUCTION . 7
SECTION 2. In Colorado Revised Statutes, add 25.5-1-135 as8
follows:9
25.5-1-135. Billing manual. U
SING EXISTING RESOURCES10
ALLOCATED FOR BILLING MANUAL REVIEWS , THE STATE DEPARTMENT11
SHALL ESTABLISH A PROCESS TO REVIEW AND UPDATE THE GENERAL12
BILLING MANUAL ON AN ANNUAL BASIS , WHICH MUST ENSURE THAT THE13
GENERAL BILLING MANUAL INCLUDES ALL NECESSARY CPT
CODES, OR14
PROVIDES LINKS TO THE STATE DEPARTMENT 'S LIST OF CPT CODES.15
16
SECTION 3. In Colorado Revised Statutes, 25.5-5-402, add (7.3)17
as follows:18
25.5-5-402. Statewide managed care system - rules -19
definitions. (7.3) (a) BEGINNING JANUARY 1, 2026, FOR A CLAIM THAT20
MUST BE REPROCESSED AS A RESULT OF UPDATING THE PROVIDER RATES ,21
AN MCO SHALL ISSUE PAYMENT TO THE CONTRACTED PROVIDER WITHIN22
ONE YEAR AFTER THE PROVIDER RATE IS UPDATED .23
(b) THE STATE DEPARTMENT SHALL NOTIFY THE MCOS OF ANY24
CHANGE TO THE PROVIDER RATES WITHIN SIXTY DAYS OF CHANGING THE25
PROVIDER RATES.26
SECTION 4. In Colorado Revised Statutes, add 25.5-5-427 as27
1213
-3- follows:1
25.5-5-427. Managed care entities - disclosure of payment and2
medical loss ratio - definition. (1) T
HE STATE DEPARTMENT SHALL3
INCLUDE IN EACH NEW CONTRACT WITH , OR RENEWAL OF A CONTRACT4
WITH, AN MCE A PROVISION REQUIRING THE MCE TO SUBMIT TO THE5
STATE DEPARTMENT, ON AN ANNUAL BASIS, THE AMOUNT THE MCE IS6
PAID FOR DELIVERING SERVICES AND THE MCE'S MEDICAL LOSS RATIO.7
(2) THE STATE DEPARTMENT SHALL ANNUALLY PUBLISH THE8
FOLLOWING INFORMATION ON ITS WEBSITE :9
(a) THE INFORMATION RECEIVED PURSUANT TO SUBSECTION (1) OF10
THIS SECTION;11
(b) HISTORICAL MEDIAL LOSS RATIO DATA FOR EACH MCE; AND12
(c) AUDIT FINDINGS REGARDING AN MCE'S MOST RECENTLY13
COMPLETED MEDICAL LOSS RATIO AUDIT .14
(3) F
OR PURPOSES OF SUBSECTION (1) OF THIS SECTION, "MEDICAL15
LOSS RATIO" MEANS THE PERCENTAGE OF PREMIUM REVENUE THAT THE16
MCE
SPENDS ON HEALTH-CARE SERVICES AND QUALITY IMPROVEMENT17
ACTIVITIES.18
SECTION
5. In Colorado Revised Statutes, add 25.5-6-117 as19
follows:20
25.5-6-117. Plan of care - rehabilitation therapy -21
requirements - definition. (1) A
S USED IN THE SECTION, UNLESS THE22
CONTEXT OTHERWISE REQUIRES , "PLAN OF CARE" HAS THE SAME MEANING23
AS SET FORTH IN SECTION 25.5-6-403.24
(2) T
HE STATE DEPARTMENT SHALL NOT IMPOSE SIGNATURE25
REQUIREMENTS BEYOND WHAT IS REQUIRED BY THE FEDERAL CENTERS FOR26
MEDICARE AND MEDICAID SERVICES PURS UANT TO 42 CFR 409.43 ON A27
1213
-4- PHYSICIAN OR PRACTITIONER CERTIFYING A MEMBER 'S PLAN OF CARE THAT1
INVOLVES PHYSICAL THERAPY, OCCUPATIONAL THERAPY, OR SPEECH2
THERAPY SERVICES.3
SECTION 6. In Colorado Revised Statutes, add 25.5-6-118 as4
follows:5
25.5-6-118. Long-term care for members with permanent6
disability. (1) FOR A MEMBER RECEIVING SERVICES THROUGH A7
LONG-TERM CARE PROGRAM PURSUANT TO PARTS 3 TO 10 OF THIS ARTICLE8
6, IF A SERVICE THE MEMBER RECEIVES IS DISCONTINUED OR IS NO LONGER9
A COVERED SERVICE, THE STATE DEPARTMENT MUST CONFIRM THE10
TIMELINE FOR CONTINUITY OF TREATMENT WITH THE FEDERAL CENTERS11
FOR MEDICARE AND MEDICAID DURING THE TRANSITION PERIOD OF THE12
BENEFIT OR SERVICE BEING DISCONTINUED. UPON CONFIRMATION, THE13
STATE DEPARTMENT SHALL COMMUNICATE THE TIMELINE TO THE MEMBER14
IMPACTED BY THE BENEFIT OR SERVICE BEING DISCONTINUED .15
(2) THIS SECTION APPLIES TO MEMBERS WHO ARE FUNCTIONALLY16
AND FINANCIALLY ELIGIBLE TO RECEIVE LONG -TERM CARE SERVICES17
PURSUANT TO PARTS 3 TO 10 OF THIS ARTICLE 6.18
SECTION 7. In Colorado Revised Statutes, 25.5-6-2001, amend19
(2)(a), (2)(c)(II), (2)(c)(III), (3)(a), and(7)(b) as follows:20
25.5-6-2001. System of care for children and youth - federal21
authorization - leadership and implementation team - report - rules22
- definition. (2) (a) No later than November 1, 2024, the state department23
shall convene a leadership team that is responsible for the24
decision-making and oversight ADVISING AND REVIEWING THE25
DEVELOPMENT AND OPERATION of the system of care for children and26
youth who have complex behavioral health needs.27
1213
-5- (c) The leadership team has the following duties and1
responsibilities:2
(II) To oversee and advise REVIEW AND ADVISE ON the strategic3
direction of the development of the system of care; and4
(III) To provide fiscal oversight of the state department's5
development and oversight of the system of care REVIEW AND COMMENT6
ON THE STATE DEPARTMENT 'S FISCAL DEVELOPMENT AND OVERSIGHT OF7
THE SYSTEM OF CARE.8
(3) (a) No later than October 1, 2024, the state department shall9
convene an implementation team that shall create a plan UTILIZING THE10
RECOMMENDATIONS FROM THE LEADERSHIP TEAM , AS APPROPRIATE, to11
implement the system of care for children and youth who have complex12
behavioral health needs.13
(7) (b) Beginning January 2025, and each quarter thereafter, the14
state department shall report progress on the development and15
implementation of the system of care developed pursuant to this section16
to the joint budget committee, THE IMPLEMENTATION TEAM , THE17
LEADERSHIP TEAM, THE SENATE HEALTH AND HUMAN SERVICES18
COMMITTEE, AND THE HOUSE OF REPRESENTATIVES HEALTH AND HUMAN19
SERVICES COMMITTEE. THE REPORT REQUIRED BY THIS SUBSECTION (7)(b)20
MUST INCLUDE THE RATIONALE FOR ANY RECOMMENDATION FROM THE21
LEADERSHIP TEAM THAT THE DEPARTMENT ELECTS NOT TO IMPLEMENT .22
SECTION 8. Act subject to petition - effective date. This act23
takes effect at 12:01 a.m. on the day following the expiration of the24
ninety-day period after final adjournment of the general assembly; except25
that, if a referendum petition is filed pursuant to section 1 (3) of article V26
of the state constitution against this act or an item, section, or part of this27
1213
-6- act within such period, then the act, item, section, or part will not take1
effect unless approved by the people at the general election to be held in2
November 2026 and, in such case, will take effect on the date of the3
official declaration of the vote thereon by the governor.4
1213
-7-