Colorado 2025 Regular Session

Colorado House Bill HB1213 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		First Regular Session
2	2		Seventy-fifth General Assembly
3	3		STATE OF COLORADO
4		-	~~REENGROSSED~~
5		-	This Version Includes All Amendments
6		-	~~Adopted~~ in the House of Introduction
	4	+	ENGROSSED
	5	+	This Version Includes All Amendments Adopted
	6	+	on Second Reading in the House of Introduction
7	7		LLS NO. 25-0820.01 Chelsea Princell x4335
8	8		HOUSE BILL 25-1213
9	9		House Committees Senate Committees
10	10		Health & Human Services
11	11		Appropriations
12	12		A BILL FOR AN ACT
13	13		C
14	14		ONCERNING CHANGES TO THE MEDICAL ASSISTANCE PROGRAM .101
15	15		Bill Summary
16	16		(Note: This summary applies to this bill as introduced and does
17	17		not reflect any amendments that may be subsequently adopted. If this bill
18	18		passes third reading in the house of introduction, a bill summary that
19	19		applies to the reengrossed version of this bill will be available at
20	20		http://leg.colorado.gov
21	21		.)
22	22		The bill exempts an assisted living residence with fewer than 19
23	23		beds that has not undergone new construction or renovations and that
24	24		complies with the standards for assisted living residences from complying
25	25		with facility guidelines adopted by the state board of health.
26	26		The bill requires the department of health care policy and
27	27		financing (state department) to follow the standards set by the federal
28	28		centers for medicare and medicaid when updating rules.
29	29		The state department must establish a process for reviewing and
30	30		HOUSE
31		-	3rd Reading Unamended
32		-	March 26, 2025
33		-	HOUSE
34	31		Amended 2nd Reading
35	32		March 25, 2025
36	33		HOUSE SPONSORSHIP
37		-	Feret and Weinberg, Bacon, Bird, Boesenecker, Duran, English, Garcia, Gonzalez R.,
38		-	Jackson, Joseph, Lieder, Lindstedt, McCluskie, Ricks, Stewart K., Stewart R., Titone
	34	+	Feret and Weinberg,
39	35		SENATE SPONSORSHIP
40	36		Daugherty and Ball,
41	37		Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
42	38		Capital letters or bold & italic numbers indicate new material to be added to existing law.
43	39		Dashes through the words or numbers indicate deletions from existing law. updating the general billing manual on an annual basis and ensure that the
44	40		general billing manual includes all necessary CPT codes.
45	41		Beginning January 1, 2026, for claims that must be reprocessed as
46	42		a result of updating the provider rates, the bill requires a managed care
47	43		organization to issue payment to a contracted provider within one year
48	44		after the provider rate is updated.
49	45		The bill requires the state department to include in each new
50	46		contract with, or renewal of a contract with, a managed care entity (MCE)
51	47		a provision requiring the MCE to submit to the state department, on an
52	48		annual basis, the amount the MCE is paid and the MCE's medical loss
53	49		ratio. The state department is required to publish this information on the
54	50		state department's website on an annual basis.
55	51		The bill prohibits the state department from imposing signature
56	52		requirements on a physician or practitioner certifying a medicaid
57	53		member's (member) plan of care that involves physical therapy or
58	54		occupational therapy.
59	55		The bill prevents a member receiving home- and community-based
60	56		services from losing the services the member currently receives if the
61	57		member's disability and need for services have not changed in the
62	58		preceding 3 years.
63	59		Be it enacted by the General Assembly of the State of Colorado:1
64	60		SECTION 1. In Colorado Revised Statutes, 25-27-104, add (3)2
65	61		as follows:3
66	62		25-27-104. Minimum standards for assisted living residences4
67	63		- rules - definition. (3) (a) RULES ADOPTED BY THE STATE BOARD5
68	64		PURSUANT TO SUBSECTION (1) OF THIS SECTION MUST EXEMPT AN6
69	65		ASSISTED LIVING RESIDENCE WITH FE WER THAN NINETEEN BEDS FROM7
70	66		COMPLYING WITH THE FACILITY GUIDELINE INSTITUTE (FGI) GUIDELINES,8
71	67		EXCEPT IN THE CASE OF NEW CONSTRUCTION OR MAJOR RENOVATIONS. AN9
72	68		ASSISTED LIVING RESIDENCE WITH FE WER THAN NINETEEN BEDS MUST10
73	69		STILL COMPLY WITH ALL OTHER FIRE AND LOCAL BUILDING CODES AND THE11
74	70		STANDARDS OUTLINED IN THIS SECTION .12
75	71		(b) FOR PURPOSES OF SUBSECTION (3)(a) OF THIS SECTION, "MAJOR13
76	72		RENOVATIONS" MEANS ADDITIONS TO A BUILDING'S STRUCTURE OR14
77	73		1213-2- CHANGES THAT AFFECT THE STRUCTURAL INTEGRITY OF THE BUILDING .1
78	74		MAJOR RENOVATIONS DO NOT INCLUDE CHANGING THE FUNCTIONAL2
79	75		OPERATION OF A SPACE IF NO CONSTRUCTION IS COMPLETED AND THE3
80	76		FLOOR PLAN OF THE BUILDING REMAINS THE SAME . IT ALSO DOES NOT4
81	77		INCLUDE ADDING BEDS TO ACCOMMODATE MORE RESIDENTS OR UPGRADES5
82	78		TO THE HEATING OR COOLING SYSTEMS AND ELECTRICAL SYSTEMS IF6
83	79		THOSE IMPROVEMENTS DO NOT REQUIRE CONSTRUCTION . 7
84	80		SECTION 2. In Colorado Revised Statutes, add 25.5-1-135 as8
85	81		follows:9
86	82		25.5-1-135. Billing manual. U
87	83		SING EXISTING RESOURCES10
88	84		ALLOCATED FOR BILLING MANUAL REVIEWS , THE STATE DEPARTMENT11
89	85		SHALL ESTABLISH A PROCESS TO REVIEW AND UPDATE THE GENERAL12
90	86		BILLING MANUAL ON AN ANNUAL BASIS , WHICH MUST ENSURE THAT THE13
91	87		GENERAL BILLING MANUAL INCLUDES ALL NECESSARY CPT
92	88		CODES, OR14
93	89		PROVIDES LINKS TO THE STATE DEPARTMENT 'S LIST OF CPT CODES.15
94	90		16
95	91		SECTION 3. In Colorado Revised Statutes, 25.5-5-402, add (7.3)17
96	92		as follows:18
97	93		25.5-5-402. Statewide managed care system - rules -19
98	94		definitions. (7.3) (a) BEGINNING JANUARY 1, 2026, FOR A CLAIM THAT20
99	95		MUST BE REPROCESSED AS A RESULT OF UPDATING THE PROVIDER RATES ,21
100	96		AN MCO SHALL ISSUE PAYMENT TO THE CONTRACTED PROVIDER WITHIN22
101	97		ONE YEAR AFTER THE PROVIDER RATE IS UPDATED .23
102	98		(b) THE STATE DEPARTMENT SHALL NOTIFY THE MCOS OF ANY24
103	99		CHANGE TO THE PROVIDER RATES WITHIN SIXTY DAYS OF CHANGING THE25
104	100		PROVIDER RATES.26
105	101		SECTION 4. In Colorado Revised Statutes, add 25.5-5-427 as27
106	102		1213
107	103		-3- follows:1
108	104		25.5-5-427. Managed care entities - disclosure of payment and2
109	105		medical loss ratio - definition. (1) T
110	106		HE STATE DEPARTMENT SHALL3
111	107		INCLUDE IN EACH NEW CONTRACT WITH , OR RENEWAL OF A CONTRACT4
112	108		WITH, AN MCE A PROVISION REQUIRING THE MCE TO SUBMIT TO THE5
113	109		STATE DEPARTMENT, ON AN ANNUAL BASIS, THE AMOUNT THE MCE IS6
114	110		PAID FOR DELIVERING SERVICES AND THE MCE'S MEDICAL LOSS RATIO.7
115	111		(2) THE STATE DEPARTMENT SHALL ANNUALLY PUBLISH THE8
116	112		FOLLOWING INFORMATION ON ITS WEBSITE :9
117	113		(a) THE INFORMATION RECEIVED PURSUANT TO SUBSECTION (1) OF10
118	114		THIS SECTION;11
119	115		(b) HISTORICAL MEDIAL LOSS RATIO DATA FOR EACH MCE; AND12
120	116		(c) AUDIT FINDINGS REGARDING AN MCE'S MOST RECENTLY13
121	117		COMPLETED MEDICAL LOSS RATIO AUDIT .14
122	118		(3) F
123	119		OR PURPOSES OF SUBSECTION (1) OF THIS SECTION, "MEDICAL15
124	120		LOSS RATIO" MEANS THE PERCENTAGE OF PREMIUM REVENUE THAT THE16
125	121		MCE
126	122		SPENDS ON HEALTH-CARE SERVICES AND QUALITY IMPROVEMENT17
127	123		ACTIVITIES.18
128	124		SECTION
129	125		5. In Colorado Revised Statutes, add 25.5-6-117 as19
130	126		follows:20
131	127		25.5-6-117. Plan of care - rehabilitation therapy -21
132	128		requirements - definition. (1) A
133	129		S USED IN THE SECTION, UNLESS THE22
134	130		CONTEXT OTHERWISE REQUIRES , "PLAN OF CARE" HAS THE SAME MEANING23
135	131		AS SET FORTH IN SECTION 25.5-6-403.24
136	132		(2) T
137	133		HE STATE DEPARTMENT SHALL NOT IMPOSE SIGNATURE25
138	134		REQUIREMENTS BEYOND WHAT IS REQUIRED BY THE FEDERAL CENTERS FOR26
139	135		MEDICARE AND MEDICAID SERVICES PURS UANT TO 42 CFR 409.43 ON A27
140	136		1213
141	137		-4- PHYSICIAN OR PRACTITIONER CERTIFYING A MEMBER 'S PLAN OF CARE THAT1
142	138		INVOLVES PHYSICAL THERAPY, OCCUPATIONAL THERAPY, OR SPEECH2
143	139		THERAPY SERVICES.3
144	140		SECTION 6. In Colorado Revised Statutes, add 25.5-6-118 as4
145	141		follows:5
146	142		25.5-6-118. Long-term care for members with permanent6
147	143		disability. (1) FOR A MEMBER RECEIVING SERVICES THROUGH A7
148	144		LONG-TERM CARE PROGRAM PURSUANT TO PARTS 3 TO 10 OF THIS ARTICLE8
149	145		6, IF A SERVICE THE MEMBER RECEIVES IS DISCONTINUED OR IS NO LONGER9
150	146		A COVERED SERVICE, THE STATE DEPARTMENT MUST CONFIRM THE10
151	147		TIMELINE FOR CONTINUITY OF TREATMENT WITH THE FEDERAL CENTERS11
152	148		FOR MEDICARE AND MEDICAID DURING THE TRANSITION PERIOD OF THE12
153	149		BENEFIT OR SERVICE BEING DISCONTINUED. UPON CONFIRMATION, THE13
154	150		STATE DEPARTMENT SHALL COMMUNICATE THE TIMELINE TO THE MEMBER14
155	151		IMPACTED BY THE BENEFIT OR SERVICE BEING DISCONTINUED .15
156	152		(2) THIS SECTION APPLIES TO MEMBERS WHO ARE FUNCTIONALLY16
157	153		AND FINANCIALLY ELIGIBLE TO RECEIVE LONG -TERM CARE SERVICES17
158	154		PURSUANT TO PARTS 3 TO 10 OF THIS ARTICLE 6.18
159	155		SECTION 7. In Colorado Revised Statutes, 25.5-6-2001, amend19
160	156		(2)(a), (2)(c)(II), (2)(c)(III), (3)(a), and(7)(b) as follows:20
161	157		25.5-6-2001. System of care for children and youth - federal21
162	158		authorization - leadership and implementation team - report - rules22
163	159		- definition. (2) (a) No later than November 1, 2024, the state department23
164	160		shall convene a leadership team that is responsible for the24
165	161		decision-making and oversight ADVISING AND REVIEWING THE25
166	162		DEVELOPMENT AND OPERATION of the system of care for children and26
167	163		youth who have complex behavioral health needs.27
168	164		1213
169	165		-5- (c) The leadership team has the following duties and1
170	166		responsibilities:2
171	167		(II) To oversee and advise REVIEW AND ADVISE ON the strategic3
172	168		direction of the development of the system of care; and4
173	169		(III) To provide fiscal oversight of the state department's5
174	170		development and oversight of the system of care REVIEW AND COMMENT6
175	171		ON THE STATE DEPARTMENT 'S FISCAL DEVELOPMENT AND OVERSIGHT OF7
176	172		THE SYSTEM OF CARE.8
177	173		(3) (a) No later than October 1, 2024, the state department shall9
178	174		convene an implementation team that shall create a plan UTILIZING THE10
179	175		RECOMMENDATIONS FROM THE LEADERSHIP TEAM , AS APPROPRIATE, to11
180	176		implement the system of care for children and youth who have complex12
181	177		behavioral health needs.13
182	178		(7) (b) Beginning January 2025, and each quarter thereafter, the14
183	179		state department shall report progress on the development and15
184	180		implementation of the system of care developed pursuant to this section16
185	181		to the joint budget committee, THE IMPLEMENTATION TEAM , THE17
186	182		LEADERSHIP TEAM, THE SENATE HEALTH AND HUMAN SERVICES18
187	183		COMMITTEE, AND THE HOUSE OF REPRESENTATIVES HEALTH AND HUMAN19
188	184		SERVICES COMMITTEE. THE REPORT REQUIRED BY THIS SUBSECTION (7)(b)20
189	185		MUST INCLUDE THE RATIONALE FOR ANY RECOMMENDATION FROM THE21
190	186		LEADERSHIP TEAM THAT THE DEPARTMENT ELECTS NOT TO IMPLEMENT .22
191	187		SECTION 8. Act subject to petition - effective date. This act23
192	188		takes effect at 12:01 a.m. on the day following the expiration of the24
193	189		ninety-day period after final adjournment of the general assembly; except25
194	190		that, if a referendum petition is filed pursuant to section 1 (3) of article V26
195	191		of the state constitution against this act or an item, section, or part of this27
196	192		1213
197	193		-6- act within such period, then the act, item, section, or part will not take1
198	194		effect unless approved by the people at the general election to be held in2
199	195		November 2026 and, in such case, will take effect on the date of the3
200	196		official declaration of the vote thereon by the governor.4
201	197		1213
202	198		-7-