CO
Colorado Senate Bill SB270

Colorado 2025 Regular Session

Colorado Senate Bill SB270 Compare Versions

OldNewDifferences
11 First Regular Session
22 Seventy-fifth General Assembly
33 STATE OF COLORADO
4-REREVISED
5-This Version Includes All Amendments
6-Adopted in the Second House
4+REVISED
5+This Version Includes All Amendments Adopted
6+on Second Reading in the Second House
77 LLS NO. 25-1037.01 Rebecca Bayetti x4348
88 SENATE BILL 25-270
99 Senate Committees House Committees
1010 Appropriations Appropriations
1111 A BILL FOR AN ACT
1212 C
1313 ONCERNING NURSING FACILITY FEES COLLECTED BY THE COLORADO101
1414 HEALTHCARE AFFORDABILITY AND SUSTAINABILITY102
1515 ENTERPRISE, AND, IN CONNECTION THEREWITH , AUTHORIZING103
1616 THE ENTERPRISE TO PROVID E ADDITIONAL SERVICES TO104
1717 NURSING FACILITIES IN EXCHANGE FOR THE FEES COLLECTED105
1818 AND MAKING AND REDUCING APPROPRIATIONS .106
1919 Bill Summary
2020 (Note: This summary applies to this bill as introduced and does
2121 not reflect any amendments that may be subsequently adopted. If this bill
2222 passes third reading in the house of introduction, a bill summary that
2323 applies to the reengrossed version of this bill will be available at
2424 http://leg.colorado.gov
2525 .)
2626 The bill repeals the existing nursing facility provider fee and
2727 HOUSE
28-3rd Reading Unamended
29-April 10, 2025
30-HOUSE
3128 Amended 2nd Reading
3229 April 9, 2025
3330 SENATE
3431 3rd Reading Unamended
3532 April 3, 2025
3633 SENATE
3734 Amended 2nd Reading
3835 April 2, 2025
3936 SENATE SPONSORSHIP
4037 Bridges and Amabile, Coleman, Cutter, Gonzales J., Hinrichsen, Kipp, Michaelson Jenet,
4138 Sullivan, Wallace, Winter F.
4239 HOUSE SPONSORSHIP
43-Bird and Sirota, McCluskie
40+Bird and Sirota,
4441 Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
4542 Capital letters or bold & italic numbers indicate new material to be added to existing law.
4643 Dashes through the words or numbers indicate deletions from existing law. intermediate care facility service fee, effective May 1, 2025, and provides
4744 that, beginning on May 1, 2025, and for each state fiscal year thereafter,
4845 the Colorado healthcare affordability and sustainability enterprise
4946 (CHASE) within the department of health care policy and financing will
5047 charge and collect a new healthcare affordability and sustainability
5148 nursing facility provider fee and a new healthcare affordability and
5249 sustainability intermediate care facility fee that function similarly to the
5350 repealed fees. The bill creates a facility provider fee enterprise support
5451 board within CHASE for the purpose of supporting the existing enterprise
5552 with the implementation of the healthcare affordability and sustainability
5653 nursing facility provider fee and the healthcare affordability and
5754 sustainability intermediate care facility fee. In exchange for payment of
5855 the healthcare affordability and sustainability nursing facility provider
5956 fee, CHASE will provide certain business services to nursing facility
6057 providers to sustain or increase reimbursement rates and make
6158 supplemental medicaid payments to nursing facility providers. In
6259 exchange for payment of the healthcare affordability and sustainability
6360 intermediate care facility fee, CHASE will provide certain business
6461 services to intermediate care facility providers for individuals with
6562 intellectual disabilities for the purposes of maintaining the quality and
6663 continuity of services provided by intermediate care facilities for
6764 individuals with intellectual disabilities. Because CHASE is an enterprise
6865 for purposes of the Taxpayer's Bill of Rights, its revenue does not count
6966 against the state fiscal year spending limit.
7067 The bill also makes conforming amendments and, for clarity,
7168 renames the existing healthcare affordability and sustainability fee and
7269 healthcare affordability and sustainability fund to be the healthcare
7370 affordability and sustainability hospital provider fee and the healthcare
7471 affordability and sustainability hospital provider fee cash fund.
7572 Be it enacted by the General Assembly of the State of Colorado:1
7673 SECTION 1. In Colorado Revised Statutes, 25.5-4-402.4, amend2
7774 (2) introductory portion, (2)(a), (2)(c) introductory portion, (2)(c)(V),3
7875 (2)(c)(VI), (2)(d) introductory portion, (2)(e), (2)(f), (2)(g), (3)(a),4
7976 (3)(c)(I), (3)(d)(I), (3)(d)(II), (3)(d)(III), (3)(d)(V), (4)(b) introductory5
8077 portion, (4)(b)(II), (4)(b)(III), (4)(c)(I) introductory portion, (4)(c)(II)(C),6
8178 (4)(c)(III) introductory portion, (4)(c)(III)(E), (4)(c)(III)(F), (4)(e), (4)(f),7
8279 (5)(a), (5)(b) introductory portion, (5)(b)(IV) introductory portion,8
8380 270-2- (5)(b)(VI)(B), (5)(c)(I)(A), (5)(c)(II)(C), (5)(c)(III), (5)(c)(V), (6)(a)(I),1
8481 (6)(b) introductory portion, (6)(b)(II), (6)(b)(III)(A), (6)(b)(III)(B), (6)(c),2
8582 (7)(b), (7)(d)(I), (7)(d)(II), (7)(d)(III), (7)(d)(IX), (7)(d)(X), (7)(e)3
8683 introductory portion, (7)(e)(II), (7)(e)(III) introductory portion, and4
8784 (7)(e)(IV); amend as they exist until July 1, 2025, (2)(d)(I), (4)(a)5
8885 introductory portion, and (4)(g); and add (2)(c)(V.5), (2)(c)(V.7),6
8986 (2)(d.5), (2)(d.7), (3)(c)(III), (3)(c)(IV), (4.5), (4.7), (5.5), (5.7),7
9087 (6)(a)(IV), (6)(a)(V), (6)(b.5), (6)(c.5), (6)(c.7), (7)(e)(II.5), (7)(e)(II.7),8
9188 (7)(e)(III.5), (7)(e)(III.7), (7)(g), (7.5), and (9) as follows:9
9289 25.5-4-402.4. Healthcare affordability and sustainability10
9390 hospital provider fee - healthcare affordability and sustainability11
9491 nursing facility provider fee - healthcare affordability and12
9592 sustainability intermediate care facility fee - Colorado healthcare13
9693 affordability and sustainability enterprise - federal waiver - funds14
9794 created - reports - rules - legislative declaration - repeal.15
9895 (2) Legislative declaration. The general assembly hereby finds and16
9996 declares that:17
10097 (a) The state and the providers of publicly funded medical18
10198 services, and hospitals,
10299 NURSING FACILITY PROVIDERS, AND INTERMEDIATE19
103100 CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES in20
104101 particular, share a common commitment to comprehensive health-care21
105102 reform;22
106103 (c) This section is enacted as part of a comprehensive health-care23
107104 reform and is intended to provide the following services and benefits to24
108105 hospitals,
109106 NURSING FACILITY PROVIDERS, INTERMEDIATE CARE FACILITIES25
110107 FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES , and individuals: 26
111108 (V) Expanding access to high-quality, affordable health care for27
112109 270
113110 -3- low-income and uninsured populations; and1
114111 (V.5) S
115112 USTAINING OR INCREASING THE REIMBURSEMENT FOR2
116113 PROVIDING MEDICAL CARE UNDER THE STATE 'S MEDICAL ASSISTANCE3
117114 PROGRAM FOR NURSING FACILITY PROVIDERS AND MAKING SUPPLEMENTAL4
118115 MEDICAID PAYMENTS TO NURSING FACILITY PROVIDERS ;5
119116 (V.7) M
120117 AINTAINING THE QUALITY AND CONTINUITY OF SERVICES6
121118 PROVIDED BY INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH7
122119 INTELLECTUAL DISABILITIES; AND8
123120 (VI) Providing the additional business services specified in9
124121 subsection (4)(a)(IV) of this section to hospitals that pay the healthcare10
125122 affordability and sustainability
126123 HOSPITAL PROVIDER fee charged and11
127124 collected as authorized by subsection (4) of this section by the Colorado12
128125 healthcare affordability and sustainability enterprise created in subsection13
129126 (3)(a) of this section;14
130127 (d) The Colorado healthcare affordability and sustainability15
131128 enterprise provides business services to hospitals when, in exchange for16
132129 payment of healthcare affordability and sustainability
133130 HOSPITAL PROVIDER17
134131 fees by hospitals, it:18
135132 (I) Obtains federal matching money and returns both the19
136133 healthcare affordability and sustainability
137134 HOSPITAL PROVIDER fee and the20
138135 federal matching money to hospitals to increase reimbursement rates to21
139136 hospitals for providing medical care under the state medical assistance22
140137 program and the Colorado indigent care program and to increase the23
141138 number of individuals covered by public medical assistance; and24
142139 (d.5) T
143140 HE COLORADO HEALTHCARE AFFORDABILITY AND25
144141 SUSTAINABILITY ENTERPRISE PROVIDES BUSINESS SERVICES TO NURSING26
145142 FACILITY PROVIDERS WHEN, IN EXCHANGE FOR PAYMENT OF NURSING27
146143 270
147144 -4- FACILITY PROVIDER FEES, IT OBTAINS FEDERAL MATCHING MONEY AND1
148145 RETURNS BOTH THE NURSING FACILITY PROVIDER FEE AND THE FEDERAL2
149146 MATCHING MONEY TO NURSING FACILITY PROVIDERS TO SUSTAIN OR3
150147 INCREASE REIMBURSEMENT RATES AND MAKE SUPPLEMENTAL MEDICAID4
151148 PAYMENTS TO NURSING FACILITY PROVIDERS ;5
152149 (d.7) T
153150 HE COLORADO HEALTHCARE AFFORDABILITY AND6
154151 SUSTAINABILITY ENTERPRISE PROVIDES BUSINESS SERVICES TO7
155152 INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL8
156153 DISABILITIES WHEN, IN EXCHANGE FOR PAYMENT OF INTERMEDIATE CARE9
157154 FACILITY FEES, IT OBTAINS FEDERAL MATCHING MONEY AND RETURNS10
158155 BOTH THE INTERMEDIATE CARE FACILITY FEE AND THE FEDERAL11
159156 MATCHING MONEY TO INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS12
160157 WITH INTELLECTUAL DISABILITIES TO SUSTAIN OR INCREASE13
161158 REIMBURSEMENT RATES AND MAKE SUPPLEMENTAL MEDICAID PAYMENTS14
162159 TO SUCH INTERMEDIATE CARE FACILITIES;15
163160 (e) It is necessary, appropriate, and in the best interest of the state16
164161 to acknowledge that by providing the business services specified in17
165162 subsections (2)(d)(I) and (2)(d)(II)
166163 SUBSECTIONS (2)(d) TO (2)(d.7) of this18
167164 section, the Colorado healthcare affordability and sustainability enterprise19
168165 engages in an activity conducted in the pursuit of a benefit, gain, or20
169166 livelihood and therefore operates as a business;21
170167 (f) Consistent with the determination of the Colorado supreme22
171168 court in Nicholl v. E-470 Public Highway Authority, 896 P.2d 859 (Colo.23
172169 1995), that the power to impose taxes is inconsistent with enterprise status24
173170 under section 20 of article X of the state constitution, it is the conclusion25
174171 of the general assembly that the healthcare affordability and sustainability26
175172 HOSPITAL PROVIDER fee, THE HEALTHCARE AFFORDABILITY AND27
176173 270
177174 -5- SUSTAINABILITY NURSING FACILITY PROVIDER FEE, AND THE HEALTHCARE1
178175 AFFORDABILITY AND SUSTAINABILITY INTERMEDIATE CARE FACILITY FEE2
179176 charged and collected by the Colorado healthcare affordability and3
180177 sustainability enterprise is a fee ARE FEES, not a tax TAXES, because the4
181178 fee is FEES ARE imposed for the specific purposes of allowing the5
182179 enterprise to defray the costs of providing the business services specified6
183180 in subsections (2)(d)(I) and (2)(d)(II) SUBSECTIONS (2)(d) TO (2)(d.7) of7
184181 this section to hospitals,
185182 NURSING FACILITY PROVIDERS , AND8
186183 INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL9
187184 DISABILITIES that pay the fee
188185 FEES and is ARE collected at rates that are10
189186 reasonably calculated based on the benefits received by those hospitals,11
190187 NURSING FACILITY PROVIDERS, AND INTERMEDIATE CARE FACILITIES; and12
191188 (g) So long as the Colorado healthcare affordability and13
192189 sustainability enterprise qualifies as an enterprise for purposes of section14
193190 20 of article X of the state constitution, the revenues from the healthcare
194191 15
195192 affordability and sustainability fee FEES charged and collected by the16
196193 enterprise are not state fiscal year spending, as defined in section17
197194 24-77-102 (17), or state revenues, as defined in section 24-77-103.618
198195 (6)(c), and do not count against either the state fiscal year spending limit19
199196 imposed by section 20 of article X of the state constitution or the excess20
200197 state revenues cap, as defined in section 24-77-103.6 (6)(b)(I).21
201198 (3) Colorado healthcare affordability and sustainability22
202199 enterprise. (a) The Colorado healthcare affordability and sustainability23
203200 enterprise referred to in this section as the "enterprise", is created. The24
204201 enterprise is and operates as a government-owned business within the25
205202 state department for the purpose of:26
206203 (I) Charging and collecting:27
207204 270
208205 -6- (A) The healthcare affordability and sustainability HOSPITAL1
209206 PROVIDER fee;2
210207 (B) T
211208 HE NURSING FACILITY PROVIDER FEE; AND3
212209 (C) T
213210 HE INTERMEDIATE CARE FACILITY FEE;4
214211 (II) Leveraging healthcare affordability and sustainability
215212 5
216213 REVENUE FROM THE HOSPITAL PROVIDER fee, revenue THE NURSING6
217214 FACILITY PROVIDER FEE, AND THE INTERMEDIATE CARE FACILITY FEE to7
218215 obtain federal matching money; and8
219216 (III) Utilizing and deploying:9
220217 (A) The healthcare affordability and sustainability HOSPITAL10
221218 PROVIDER fee revenue and federal matching money to provide the11
222219 business services specified in subsections (2)(d)(I) and (2)(d)(II) of this12
223220 section to hospitals that pay the healthcare affordability and sustainability13
224221 fee; 14
225222 (B) T
226223 HE NURSING FACILITY PROVIDER FEE REVENUE AND ANY15
227224 FEDERAL MATCHING MONEY TO PROVIDE THE BUSINESS SERVICES16
228225 SPECIFIED IN SUBSECTION (2)(d.5) OF THIS SECTION TO NURSING FACILITY17
229226 PROVIDERS THAT PAY THE NURSING FACILITY PROVIDER FEE ; AND18
230227 (C) T
231228 HE INTERMEDIATE CARE FACILITY FEE REVENUE AND ANY19
232229 FEDERAL MATCHING MONEY TO PROVIDE THE BUSINESS SERVICES20
233230 SPECIFIED IN SUBSECTION (2)(d.7) OF THIS SECTION TO INTERMEDIATE21
234231 CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES THAT22
235232 PAY THE INTERMEDIATE CARE FACILITY FEE .23
236233 (c) (I) The repeal of the hospital provider fee program, as it24
237234 existed pursuant to section 25.5-4-402.3 before its repeal, effective July25
238235 1, 2017, by Senate Bill 17-267, enacted in 2017, and the creation of the26
239236 Colorado healthcare affordability and sustainability enterprise as a new27
240237 270
241238 -7- enterprise to charge and collect a new healthcare affordability and1
242239 sustainability
243240 HOSPITAL PROVIDER fee as authorized by subsection (4) of2
244241 this section and provide healthcare affordability and sustainability
245242 3
246243 fee-funded business services to hospitals that replace and supplement4
247244 services previously funded by
248245 THE REPEALED hospital provider fees is the5
249246 creation of a new government-owned business that provides business6
250247 services to hospitals as a new enterprise for purposes of section 20 of7
251248 article X of the state constitution, does not constitute the qualification of8
252249 an existing government-owned business as an enterprise for purposes of9
253250 section 20 of article X of the state constitution or section 24-77-103.610
254251 (6)(b)(II), and, therefore, does not require or authorize adjustment of the11
255252 state fiscal year spending limit calculated pursuant to section 20 of article12
256253 X of the state constitution or the excess state revenues cap, as defined in13
257254 section 24-77-103.6 (6)(b)(I).14
258255 (III) T
259256 HE REPEAL OF THE NURSING FACILITY PROVIDER FEE15
260257 PROGRAM, AS IT EXISTED IN SECTION 25.5-6-203 (1) BEFORE ITS REPEAL,16
261258 EFFECTIVE MAY 1, 2025, BY SENATE BILL 25-270
262259 , ENACTED IN 2025, AND17
263260 THE ENTERPRISE'S ABILITY TO CHARGE AND COLLECT A NEW HEALTHCARE18
264261 AFFORDABILITY AND SUSTAINABILITY NURSING FACILITY PROVIDER FEE AS19
265262 AUTHORIZED BY SUBSECTION (4.5) OF THIS SECTION AND PROVIDE20
266263 FEE-FUNDED BUSINESS SERVICES TO NURSING FACILITY PROVIDERS THAT21
267264 REPLACE AND SUPPLEMENT SERVICES PREVIOUSLY FUNDED BY THE22
268265 NURSING FACILITY PROVIDER FEE DOES NOT CONSTITUTE CREATION OF A23
269266 NEW ENTERPRISE OR THE QUALIFICATION OF AN EXISTING24
270267 GOVERNMENT-OWNED BUSINESS AS AN ENTERPRISE FOR PURPOSES OF25
271268 SECTION 20 OF ARTICLE X OF THE STATE CONSTITUTION , SECTION26
272269 24-77-103.6 (6)(b)(II),
273270 OR SECTION 24-77-108, AND, THEREFORE, DOES27
274271 270
275272 -8- NOT REQUIRE OR AUTHORIZE ADJUSTMENT OF THE STATE FISCAL YEAR1
276273 SPENDING LIMIT CALCULATED PURSUANT TO SECTION 20 OF ARTICLE X OF2
277274 THE STATE CONSTITUTION OR THE EXCESS STATE REVENUES CAP , AS3
278275 DEFINED IN SECTION 24-77-103.6 (6)(b)(I), AND DOES NOT REQUIRE VOTER4
279276 APPROVAL.5
280277 (IV) T
281278 HE REPEAL OF THE INTERMEDIATE CARE FACILITY SERVICE6
282279 FEE PROGRAM, AS IT EXISTED IN SECTION 25.5-6-204 (1)(c)(I) BEFORE ITS7
283280 REPEAL, EFFECTIVE MAY 1, 2025, BY SENATE BILL 25-270
284281 , ENACTED IN8
285282 2025,
286283 AND THE ENTERPRISE'S ABILITY TO CHARGE AND COLLECT A NEW9
287284 HEALTHCARE AFFORDABILITY AND SUSTAINABILITY INTERMEDIATE CARE10
288285 FACILITY FEE AS AUTHORIZED BY SUBSECTION (4.7) OF THIS SECTION AND11
289286 PROVIDE FEE-FUNDED BUSINESS SERVICES TO INTERMEDIATE CARE12
290287 FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES THAT13
291288 REPLACE AND SUPPLEMENT SERVICES PREVIOUSLY FUNDED BY THE14
292289 INTERMEDIATE CARE FACILITY SERVICE FEE DOES NOT CONSTITUTE15
293290 CREATION OF A NEW ENTERPRISE OR THE QUALIFICATION OF AN EXISTING16
294291 GOVERNMENT-OWNED BUSINESS AS AN ENTERPRISE FOR PURPOSES OF17
295292 SECTION 20 OF ARTICLE X OF THE STATE CONSTITUTION , SECTION18
296293 24-77-103.6 (6)(b)(II),
297294 OR SECTION 24-77-108, AND, THEREFORE, DOES19
298295 NOT REQUIRE OR AUTHORIZE ADJUSTMENT OF THE STATE FISCAL YEAR20
299296 SPENDING LIMIT CALCULATED PURSUANT TO SECTION 20 OF ARTICLE X OF21
300297 THE STATE CONSTITUTION OR THE EXCESS STATE REVENUES CAP , AS22
301298 DEFINED IN SECTION 24-77-103.6 (6)(b)(I), AND DOES NOT REQUIRE VOTER23
302299 APPROVAL.24
303300 (d) The enterprise's primary powers and duties are:25
304301 (I) To charge and collect:26
305302 (A) The healthcare affordability and sustainability
306303 HOSPITAL27
307304 270
308305 -9- PROVIDER fee as specified in subsection (4) of this section;1
309306 (B) T
310307 HE NURSING FACILITY PROVIDER FEE AS SPECIFIED IN2
311308 SUBSECTION (4.5) OF THIS SECTION; AND3
312309 (C) T
313310 HE INTERMEDIATE CARE FACILITY FEE AS SPECIFIED IN4
314311 SUBSECTION (4.7) OF THIS SECTION;5
315312 (II) To leverage healthcare affordability and sustainability
316313 6
317314 REVENUE FROM THE HOSPITAL PROVIDER fee, revenue collected THE7
318315 NURSING FACILITY PROVIDER FEE, AND THE INTERMEDIATE CARE FACILITY8
319316 FEE to obtain federal matching money, working with or through the state9
320317 department and the state board to the extent required by federal law or10
321318 otherwise necessary;11
322319 (III) To expend:12
323320 (A) healthcare affordability and sustainability HOSPITAL PROVIDER13
324321 fee revenue, matching federal money, and any other money from the14
325322 healthcare affordability and sustainability HOSPITAL PROVIDER fee cash15
326323 fund as specified in subsections (4) and (5) of this section;16
327324 (B) N
328325 URSING FACILITY PROVIDER FEE REVENUE , MATCHING17
329326 FEDERAL MONEY, AND ANY OTHER MONEY FROM THE NURSING FACILITY18
330327 PROVIDER FEE CASH FUND AS SPECIFIED IN SUBSECTION (5.5) OF THIS19
331328 SECTION; AND20
332329 (C) I
333330 NTERMEDIATE CARE FACILITY FEE REVENUE , MATCHING21
334331 FEDERAL MONEY, AND ANY OTHER MONEY FROM THE INTERMEDIATE CARE22
335332 FACILITY FEE CASH FUND AS SPECIFIED IN SUBSECTION (5.7) OF THIS23
336333 SECTION;24
337334 (V) To enter into agreements with the state department to the25
338335 extent necessary to collect and expend healthcare affordability and
339336 26
340337 sustainability REVENUE FROM THE HOSPITAL PROVIDER fee, revenue THE27
341338 270
342339 -10- NURSING FACILITY PROVIDER FEE, AND THE INTERMEDIATE CARE FACILITY1
343340 FEE;2
344341 (4) Healthcare affordability and sustainability hospital3
345342 provider fee. (a) For the fiscal year commencing July 1, 2017, and for4
346343 each fiscal year thereafter, the enterprise is authorized to charge and5
347344 collect a healthcare affordability and sustainability
348345 HOSPITAL PROVIDER6
349346 fee, as described in 42 CFR 433.68 (b), on outpatient and inpatient7
350347 services provided by all licensed or certified hospitals referred to in this
351348 8
352349 section as "hospitals", for the purpose of obtaining federal financial9
353350 participation under the state medical assistance program as described in10
354351 this article 4 and articles 5 and 6 of this title 25.5 referred to in this11
355352 section as the "state medical assistance program", and the Colorado12
356353 indigent care program described in part 1 of article 3 of this title 25.5,13
357354 referred to in this section as the "Colorado indigent care program". If the14
358355 amount of healthcare affordability and sustainability HOSPITAL PROVIDER15
359356 fee revenue collected exceeds the federal net patient revenue-based limit16
360357 on the amount of such fee revenue that may be collected, requiring17
361358 repayment to the federal government of excess federal matching money18
362359 received, hospitals that received such excess federal matching money19
363360 shall be responsible for repaying the excess federal money and any20
364361 associated federal penalties to the federal government. The enterprise21
365362 shall use the healthcare affordability and sustainability HOSPITAL22
366363 PROVIDER fee revenue to:23
367364 (b) The enterprise shall recommend for approval and24
368365 establishment by the state board the amount of the healthcare affordability25
369366 and sustainability HOSPITAL PROVIDER fee that it intends to charge and26
370367 collect. The state board must establish the final amount of the fee by rules27
371368 270
372369 -11- promulgated in accordance with article 4 of title 24. The state board shall1
373370 not establish any amount that exceeds the federal limit for such fees. The2
374371 state board may deviate from the recommendations of the enterprise, but3
375372 shall express in writing the reasons for any deviations. In establishing the4
376373 amount of the fee and in promulgating the rules governing the fee, the5
377374 state board shall:6
378375 (II) Establish the amount of the healthcare affordability and7
379376 sustainability HOSPITAL PROVIDER fee so that the amount collected from8
380377 the fee and federal matching funds associated with the fee are sufficient9
381378 to pay for the items described in subsection (4)(a) of this section, but10
382379 nothing in this subsection (4)(b)(II) requires the state board to increase11
383380 the fee above the amount recommended by the enterprise; and12
384381 (III) For the 2017-18 fiscal year, establish the amount of the13
385382 healthcare affordability and sustainability HOSPITAL PROVIDER fee so that14
386383 the amount collected from the fee is approximately equal to the sum of15
387384 the amounts of the appropriations specified for the fee in the general16
388385 appropriation act, Senate Bill 17-254, enacted in 2017, and any other17
389386 supplemental appropriation act.18
390387 (c) (I) In accordance with the redistributive method set forth in 4219
391388 CFR 433.68 (e)(1) and (e)(2), the enterprise, acting in concert with or20
392389 through an agreement with the state department if required by federal law,21
393390 may seek a waiver from the broad-based healthcare affordability and22
394391 sustainability HOSPITAL PROVIDER fee requirement or the uniform23
395392 healthcare affordability and sustainability HOSPITAL PROVIDER fee24
396393 requirement, or both. In addition, the enterprise, acting in concert with or25
397394 through an agreement with the state department if required by federal law,26
398395 shall seek any federal waiver necessary to fund and, in cooperation with27
399396 270
400397 -12- the state department and hospitals, support the implementation of a1
401398 health-care delivery system reform incentive payments program as2
402399 described in subsection (8) of this section. Subject to federal approval and3
403400 to minimize the financial impact on certain hospitals, the enterprise may4
404401 exempt from payment of the healthcare affordability and sustainability5
405402 HOSPITAL PROVIDER fee certain types of hospitals, including but not6
406403 limited to:7
407404 (II) In determining whether a hospital may be excluded, the8
408405 enterprise shall use one or more of the following criteria:9
409406 (C) A hospital whose inclusion or exclusion would not10
410407 significantly affect the net benefit to hospitals paying the healthcare11
411408 affordability and sustainability HOSPITAL PROVIDER fee; or12
412409 (III) The enterprise may reduce the amount of the healthcare13
413410 affordability and sustainability HOSPITAL PROVIDER fee for certain14
414411 hospitals to obtain federal approval and to minimize the financial impact15
415412 on certain hospitals. In determining for which hospitals the enterprise may16
416413 reduce the amount of the healthcare affordability and sustainability17
417414 HOSPITAL PROVIDER fee, the enterprise shall use one or more of the18
418415 following criteria:19
419416 (E) If the hospital paid a reduced healthcare affordability and20
420417 sustainability HOSPITAL PROVIDER fee, the reduced fee would not21
421418 significantly affect the net benefit to hospitals paying the healthcare22
422419 affordability and sustainability fee; or23
423420 (F) The hospital is required not to pay a reduced healthcare24
424421 affordability and sustainability HOSPITAL PROVIDER fee as a condition of25
425422 federal approval.26
426423 (e) (I) The enterprise shall establish policies on the calculation,27
427424 270
428425 -13- assessment, and timing of the healthcare affordability and sustainability1
429426 HOSPITAL PROVIDER fee. The enterprise shall assess the healthcare2
430427 affordability and sustainability HOSPITAL PROVIDER fee on a schedule to3
431428 be set by the enterprise board as provided in subsection (7)(d) of this4
432429 section. The periodic healthcare affordability and sustainability HOSPITAL5
433430 PROVIDER fee payments from a hospital and the enterprise's6
434431 reimbursement to the hospital under subsections (5)(b)(I) and (5)(b)(II)7
435432 of this section are due as nearly simultaneously as feasible; except that the8
436433 enterprise's reimbursement to the hospital is due no more than two days9
437434 after the periodic healthcare affordability and sustainability HOSPITAL10
438435 PROVIDER fee payment is received from the hospital. The healthcare11
439436 affordability and sustainability HOSPITAL PROVIDER fee must be imposed12
440437 on each hospital even if more than one hospital is owned by the same13
441438 entity. The fee must be prorated and adjusted for the expected volume of14
442439 service for any year in which a hospital opens or closes.15
443440 (II) The enterprise is authorized to refund any unused portion of16
444441 the healthcare affordability and sustainability HOSPITAL PROVIDER fee. For17
445442 any portion of the healthcare affordability and sustainability HOSPITAL18
446443 PROVIDER fee that has been collected by the enterprise but for which the19
447444 enterprise has not received federal matching funds, the enterprise shall20
448445 refund back to the hospital that paid the fee the amount of that portion of21
449446 the fee within five business days after the fee is collected.22
450447 (III) The enterprise shall establish requirements for the reports that23
451448 hospitals must submit to the enterprise to allow the enterprise to calculate24
452449 the amount of the healthcare affordability and sustainability HOSPITAL25
453450 PROVIDER fee. Notwithstanding the provisions of part 2 of article 72 of26
454451 title 24 or subsection (7)(f) of this section, information provided to the27
455452 270
456453 -14- enterprise pursuant to this section is confidential and is not a public1
457454 record. Nonetheless, the enterprise may prepare and release summaries of2
458455 the reports to the public.3
459456 (f) A hospital shall not include any amount of the healthcare4
460457 affordability and sustainability HOSPITAL PROVIDER fee as a separate line5
461458 item in its billing statements.6
462459 (g) The state board shall promulgate any rules pursuant to the7
463460 "State Administrative Procedure Act", article 4 of title 24, necessary for8
464461 the administration and implementation of this section. Prior to submitting9
465462 any proposed rules concerning the administration or implementation of10
466463 the healthcare affordability and sustainability HOSPITAL PROVIDER fee to11
467464 the state board, the enterprise shall consult with the state board on the12
468465 proposed rules as specified in subsection (7)(d) of this section.13
469466 (4.5) Healthcare affordability and sustainability nursing14
470467 facility provider fee. (a) B
471468 EGINNING ON MAY 1, 2025, THE ENTERPRISE15
472469 IS AUTHORIZED TO CHARGE AND COLLECT A HEALTHCARE AFFORDABILITY16
473470 AND SUSTAINABILITY NURSING FACILITY PROVIDER FEE ON HEALTH -CARE17
474471 ITEMS OR SERVICES PROVIDED BY NURSING FACILITY PROVIDERS FOR THE18
475472 PURPOSE OF OBTAINING FEDERAL FINANCIAL PARTICIPATION UNDER THE19
476473 STATE MEDICAL ASSISTANCE PROGRAM AS DESCRIBED IN THIS ARTICLE 420
477474 AND ARTICLES 5 AND 6 OF THIS TITLE 25.5. THE ENTERPRISE SHALL USE21
478475 THE NURSING FACILITY PROVIDER FEE REVENUE TO PROVIDE A BUSINESS22
479476 SERVICE TO NURSING FACILITY PROVIDERS BY SUSTAINING OR INCREASING23
480477 REIMBURSEMENT FOR PROVIDING MEDICAL CARE UNDER THE STATE24
481478 MEDICAL ASSISTANCE PROGRAM FOR NURSING FACILITY PROVIDERS AND25
482479 MAKING SUPPLEMENTAL MEDICAID PAYMENTS TO NURSING FACILITY26
483480 PROVIDERS, AS SPECIFIED BY THE PRIORITY OF THE USES OF THE NURSING27
484481 270
485482 -15- FACILITY PROVIDER FEE REVENUE SET FORTH IN SUBSECTION (5.5)(b) OF1
486483 THIS SECTION.2
487484 (b) T
488485 HE ENTERPRISE SHALL RECOMMEND FOR APPROVAL AND3
489486 ESTABLISHMENT BY THE STATE BOARD THE AMOUNT OF THE NURSING4
490487 FACILITY PROVIDER FEE THAT IT INTENDS TO CHARGE AND COLLECT . THE5
491488 STATE BOARD MUST ESTABLISH THE FINAL AMOUNT OF THE FEE BY RULE .6
492489 T
493490 HE STATE BOARD SHALL NOT ESTABLISH ANY AMOUNT THAT EXCEEDS7
494491 THE FEDERAL LIMIT FOR SUCH FEES . THE STATE BOARD MAY DEVIATE8
495492 FROM THE RECOMMENDATIONS OF THE ENTERPRISE , BUT SHALL EXPRESS9
496493 IN WRITING THE REASONS FOR ANY DEVIATIONS . IN ESTABLISHING THE10
497494 AMOUNT OF THE FEE AND IN PROMULGATING THE RULES GOVERNING THE11
498495 FEE, THE STATE BOARD SHALL:12
499496 (I) C
500497 ONSIDER RECOMMENDATIONS OF THE ENTERPRISE ; AND13
501498 (II) E
502499 STABLISH THE AMOUNT OF THE NURSING FACILITY PROVIDER14
503500 FEE SO THAT THE AMOUNT COLLECTED FROM THE FEE AND FEDERAL15
504501 MATCHING FUNDS ASSOCIATED WITH THE FEE ARE SUFFICIENT TO PAY FOR16
505502 THE ITEMS DESCRIBED IN SUBSECTION (4.5)(a) OF THIS SECTION, BUT17
506503 NOTHING IN THIS SUBSECTION (4.5)(b)(II) REQUIRES THE STATE BOARD TO18
507504 INCREASE THE FEE ABOVE THE AMOUNT RECOMMENDED BY THE19
508505 ENTERPRISE.20
509506 (c) T
510507 HE ENTERPRISE SHALL NOT CHARGE OR COLLECT THE NURSING21
511508 FACILITY PROVIDER FEE IN THE ABSENCE OF THE FEDERAL GOVERNMENT 'S22
512509 APPROVAL OF A STATE MEDICAID PLAN AMENDMENT AUTHORIZING23
513510 FEDERAL FINANCIAL PARTICIPATION FOR THE NURSING FACILITY PROVIDER24
514511 FEE. THE ENTERPRISE MAY ALTER THE PROCESS PRESCRIBED IN THIS25
515512 SUBSECTION (4.5) TO THE EXTENT NECESSARY TO MEET FEDERAL26
516513 REQUIREMENTS AND TO OBTAIN FEDERAL APPROVAL . THE ENTERPRISE27
517514 270
518515 -16- MAY LOWER THE AMOUNT OF THE NURSING FACILITY PROVIDER FEE1
519516 CHARGED TO CERTAIN NURSING FACILITY PROVIDERS TO MEET THE2
520517 REQUIREMENTS OF 42 CFR 433.68 (e) AND TO OBTAIN FEDERAL3
521518 APPROVAL.4
522519 (d) (I) I
523520 N ACCORDANCE WITH THE REDISTRIBUTIVE MET HOD SET5
524521 FORTH IN 42 CFR 433.68 (e)(1) AND (e)(2), THE ENTERPRISE, ACTING IN6
525522 CONCERT WITH OR THROUGH AN AGREEMENT WITH THE STATE7
526523 DEPARTMENT IF REQUIRED BY FEDERAL LAW , MAY SEEK A WAIVER FROM8
527524 THE BROAD-BASED NURSING FACILITY PROVIDER FEE REQUIREMENT OR9
528525 THE UNIFORM NURSING FACILITY PROVIDER FEE REQUIREMENT , OR BOTH.10
529526 (II) S
530527 UBJECT TO FEDERAL APPROVAL AND TO MINIMIZE THE11
531528 FINANCIAL IMPACT ON CERTAIN NURSING FACILITY PROVIDERS , THE12
532529 ENTERPRISE MAY EXEMPT FROM PAYMENT OF THE NURSING FACILITY13
533530 PROVIDER FEE CERTAIN TYPES OF NURSING PROVIDER FACILITIES ,14
534531 INCLUDING BUT NOT LIMITED TO:15
535532 (A) A
536533 FACILITY OPERATED AS A CONTINUING CARE RETIREMENT16
537534 COMMUNITY THAT PROVIDES A CONTINUUM OF SERVICES BY ONE17
538535 OPERATIONAL ENTITY PROVIDING INDEPENDENT LIVING SERVICES ,18
539536 ASSISTED LIVING SERVICES, AND SKILLED NURSING CARE ON A SINGLE ,19
540537 CONTIGUOUS CAMPUS. ASSISTED LIVING SERVICES INCLUDE AN ASSISTED20
541538 LIVING RESIDENCE AS DEFINED IN SECTION 25-27-102 OR A FACILITY THAT21
542539 PROVIDES ASSISTED LIVING SERVICES ON-SITE, TWENTY-FOUR HOURS PER22
543540 DAY, SEVEN DAYS PER WEEK.23
544541 (B) A
545542 SKILLED NURSING FACILITY OWNED AND OPERATED BY THE24
546543 STATE;25
547544 (C) A
548545 NURSING FACILITY THAT IS A DISTINCT PART OF A FACILITY26
549546 THAT IS LICENSED AS A GENERAL ACUTE CARE HOSPITAL ; AND27
550547 270
551548 -17- (D) A FACILITY THAT HAS FORTY-FIVE OR FEWER LICENSED BEDS.1
552549 (e) (I) T
553550 HE ENTERPRISE SHALL ESTABLISH POLICIES ON THE2
554551 CALCULATION, ASSESSMENT, AND TIMING OF THE NURSING FACILITY3
555552 PROVIDER FEE. THE ENTERPRISE SHALL ASSESS THE NURSING FACILITY4
556553 PROVIDER FEE ON A MONTHLY BASIS . THE NURSING FACILITY PROVIDER5
557554 FEE PAYMENTS FROM A NURSING FACILITY PROVIDER AND THE6
558555 ENTERPRISE'S REIMBURSEMENT AND SUPPLEMENTAL PAYMENTS TO THE7
559556 NURSING FACILITY PROVIDER UNDER SUBSECTION (5.5)(b) OF THIS SECTION8
560557 ARE DUE AS NEARLY SIMULTANEOUSLY AS FEASIBLE ; EXCEPT THAT THE9
561558 ENTERPRISE'S REIMBURSEMENT AND SUPPLEMENTAL PAYMENTS TO THE10
562559 NURSING FACILITY PROVIDER ARE DUE NO MORE THAN FIFTEEN DAYS11
563560 AFTER THE NURSING FACILITY PROVIDER FEE PAYMENT IS RECEIVED FROM12
564561 THE NURSING FACILITY PROVIDER.13
565562 (II) T
566563 HE ENTERPRISE SHALL ESTABLISH REQUIREMENTS FOR THE14
567564 REPORTS THAT NURSING FACILITY PROVIDERS MUST SUBMIT TO THE15
568565 ENTERPRISE TO ALLOW THE ENTERPRISE TO CALCULATE THE AMOUNT OF16
569566 THE NURSING FACILITY PROVIDER FEE, INCLUDING A REQUIREMENT THAT17
570567 EACH NURSING FACILITY PROVIDER REPORT ANNUALLY ITS TOTAL NUMBER18
571568 OF DAYS OF CARE PROVIDED TO NONMEDICARE RESIDENTS .19
572569 N
573570 OTWITHSTANDING PART 2 OF ARTICLE 72 OF TITLE 24 OR SUBSECTION20
574571 (7)(f)
575572 OF THIS SECTION, INFORMATION PROVIDED TO THE ENTERPRISE21
576573 PURSUANT TO THIS SUBSECTION (4.5)(e)(II) IS CONFIDENTIAL AND IS NOT22
577574 A PUBLIC RECORD. NONETHELESS, THE ENTERPRISE MAY PREPARE AND23
578575 RELEASE SUMMARIES OF THE REPORTS TO THE PUBLIC .24
579576 (f) A
580577 NURSING FACILITY PROVIDER SHALL NOT INCLUDE ANY25
581578 AMOUNT OF THE NURSING FACILITY PROVIDER FEE AS A SEPARATE LINE26
582579 ITEM IN ITS BILLING STATEMENTS.27
583580 270
584581 -18- (g) (I) THE STATE BOARD SHALL ADOPT ANY RULES PURSUANT TO1
585582 THE "STATE ADMINISTRATIVE PROCEDURE ACT", ARTICLE 4 OF TITLE 24,2
586583 NECESSARY FOR THE ADMINISTRATION AND IMPLEMENTATION OF THIS3
587584 SECTION. PRIOR TO SUBMITTING ANY PROPOSED RULES CONCERNING THE4
588585 ADMINISTRATION OR IMPLEMENTATION OF THE NURSING FACILITY5
589586 PROVIDER FEE TO THE STATE BOARD , THE ENTERPRISE SHALL CONSULT6
590587 WITH THE STATE BOARD ON THE PROPOSED RULES AS SPECIFIED IN7
591588 SUBSECTION (7)(g) OF THIS SECTION.8
592589 (4.7) Healthcare affordability and sustainability intermediate9
593590 care facility fee. (a) B
594591 EGINNING ON MAY 1, 2025, THE ENTERPRISE IS10
595592 AUTHORIZED TO CHARGE AND COLLECT A HEALTHCARE AFFORDABILITY11
596593 AND SUSTAINABILITY INTERMEDIATE CARE FACILITY FEE ON BOTH12
597594 PRIVATELY OWNED AND STATE-OPERATED INTERMEDIATE CARE FACILITIES13
598595 FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES FOR THE PURPOSE OF14
599596 MAINTAINING THE QUALITY AND CONTINUITY OF SERVICES PROVIDED BY15
600597 INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL16
601598 DISABILITIES. THE ENTERPRISE SHALL USE THE INTERMEDIATE CARE17
602599 FACILITY FEE REVENUE TO PROVIDE A BUSINESS SERVICE TO SUCH18
603600 INTERMEDIATE CARE FACILITIES BY SUSTAINING OR INCREASING19
604601 REIMBURSEMENT TO SUCH FACILITIES , AS SPECIFIED IN SUBSECTION20
605602 (5.7)(b)
606603 OF THIS SECTION.21
607604 (b) T
608605 HE ENTERPRISE SHALL RECOMMEND FOR APPROVAL AND22
609606 ESTABLISHMENT BY THE STATE BOARD THE AMOUNT OF THE23
610607 INTERMEDIATE CARE FACILITY FEE THAT IT INTENDS TO CHARGE AND24
611608 COLLECT, WHICH MUST NOT EXCEED FIVE PERCENT OF THE TOTAL COSTS25
612609 INCURRED BY ALL INTERMEDIATE CARE FACILITIES FOR THE FISCAL YEAR26
613610 IN WHICH THE FEE IS CHARGED. THE STATE BOARD MUST ESTABLISH THE27
614611 270
615612 -19- FINAL AMOUNT OF THE FEE BY RULE . THE STATE BOARD SHALL NOT1
616613 ESTABLISH ANY AMOUNT THAT EXCEEDS THE FEDERAL LIMIT FOR SUCH2
617614 FEES. THE STATE BOARD MAY DEVIATE FROM THE RECOMMENDATIONS OF3
618615 THE ENTERPRISE, BUT SHALL EXPRESS IN WRITING THE REASONS FOR ANY4
619616 DEVIATIONS.5
620617 (c) T
621618 HE ENTERPRISE MAY ALTER THE PROCESS PRESCRIBED IN THIS6
622619 SUBSECTION (4.7) TO THE EXTENT NECESSARY TO MEET FEDERAL7
623620 REQUIREMENTS.8
624621 (d) (I) T
625622 HE ENTERPRISE SHALL ESTABLISH POLICIES ON THE9
626623 CALCULATION, ASSESSMENT, AND TIMING OF THE INTERMEDIATE CARE10
627624 FACILITY FEE.11
628625 (II) T
629626 HE ENTERPRISE SHALL ESTABLISH REQUIREMENTS FOR THE12
630627 REPORTS THAT INTERMEDIATE CARE FACILITIES MUST SUBMIT TO THE13
631628 ENTERPRISE TO ALLOW THE ENTERPRISE TO CALCULATE THE AMOUNT OF14
632629 THE INTERMEDIATE CARE FACILITY FEE . NOTWITHSTANDING PART 2 OF15
633630 ARTICLE 72 OF TITLE 24 OR SUBSECTION (7)(f) OF THIS SECTION,16
634631 INFORMATION PROVIDED TO THE ENTERPRISE PURSUANT TO THIS17
635632 SUBSECTION (4.7)(d)(II) IS CONFIDENTIAL AND IS NOT A PUBLIC RECORD.18
636633 N
637634 ONETHELESS, THE ENTERPRISE MAY PREPARE AND RELEASE SUMMARIES19
638635 OF THE REPORTS TO THE PUBLIC.20
639636 (e) T
640637 HE STATE BOARD SHALL ADOPT ANY RULES PURSUANT TO THE21
641638 "S
642639 TATE ADMINISTRATIVE PROCEDURE ACT", ARTICLE 4 OF TITLE 24,22
643640 NECESSARY FOR THE ADMINISTRATION AND IMPLEMENTATION OF THIS23
644641 SECTION. PRIOR TO SUBMITTING ANY PROPOSED RULES CONCERNING THE24
645642 ADMINISTRATION OR IMPLEMENTATION OF THE INTERMEDIATE CARE25
646643 FACILITY FEE TO THE STATE BOARD , THE ENTERPRISE SHALL CONSULT26
647644 WITH THE STATE BOARD ON THE PROPOSED RULES AS SPECIFIED IN27
648645 270
649646 -20- SUBSECTION (7)(g) OF THIS SECTION.1
650647 (5) Healthcare affordability and sustainability hospital2
651648 provider fee cash fund. (a) (I) Any healthcare affordability and3
652649 sustainability
653650 HOSPITAL PROVIDER fee collected pursuant to this section4
654651 by the enterprise must be transmitted to the state treasurer, who shall5
655652 credit the fee to the healthcare affordability and sustainability
656653 HOSPITAL6
657654 PROVIDER fee cash fund, which fund is hereby
658655 created. and referred to in7
659656 this section as the "fund". The state treasurer shall credit all interest and8
660657 income derived from the deposit and investment of money in the9
661658 HOSPITAL PROVIDER FEE CASH fund to the fund. The state treasurer shall10
662659 invest any money in the
663660 HOSPITAL PROVIDER FEE CASH fund not expended11
664661 for the purposes specified in subsection (5)(b) of this section as provided12
665662 by law. Money in the
666663 HOSPITAL PROVIDER FEE CASH fund shall not be13
667664 transferred to any other fund and shall not be used for any purpose other14
668665 than the purposes specified in this subsection (5) and in subsection (4) of15
669666 this section.16
670667 (II) (A) T
671668 HE FUND CREATED IN THIS SUBSECTION (5)(a) WAS17
672669 RENAMED AS THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITY18
673670 HOSPITAL PROVIDER FEE CASH FUND IN SENATE BILL 25-270
674671 , ENACTED IN19
675672 2025.
676673 FOR PURPOSES OF THE ANNUAL GENERAL APPROPRIATION ACTS FOR20
677674 THE 2024-25 AND 2025-26 STATE FISCAL YEARS, THE CASH FUNDS21
678675 APPROPRIATIONS MADE TO THE DEPARTMENT OF HEALTH CARE POLICY22
679676 AND FINANCING FROM THE HEALTHCARE AFFORDABILITY AND23
680677 SUSTAINABILITY FEE CASH FUND, AS THE FUND WAS NAMED PRIOR TO THE24
681678 ENACTMENT OF SENATE BILL 25-270
682679 , ENACTED IN 2025, ARE FROM THE25
683680 HEALTHCARE AFFORDABILITY AND SUSTAINABILITY HOSPITAL PROVIDER26
684681 FEE CASH FUND, AS RENAMED BY SENATE BILL 25-270, ENACTED IN 2025.27
685682 270
686683 -21- (B) THIS SUBSECTION (5)(a)(II) IS REPEALED, EFFECTIVE JULY 1,1
687684 2027.2
688685 (b) All money in the
689686 HOSPITAL PROVIDER FEE CASH fund is subject3
690687 to federal matching as authorized under federal law and, subject to annual4
691688 appropriation by the general assembly, shall be expended by the5
692689 enterprise for the following purposes:6
693690 (IV) Subject to available revenue from the healthcare affordability
694691 7
695692 and sustainability HOSPITAL PROVIDER fee and federal matching funds, to8
696693 expand eligibility for public medical assistance by:9
697694 (VI) To pay the enterprise's actual administrative costs of10
698695 implementing and administering this section, including but not limited to11
699696 the following costs:12
700697 (B) The enterprise's actual costs related to implementing and13
701698 maintaining the healthcare affordability and sustainability HOSPITAL14
702699 PROVIDER fee, including personal services, operating, and consulting15
703700 expenses;16
704701 (c) ARPA home- and community-based services account.17
705702 (I) (A) There is created the "ARPA home- and community-based services18
706703 account" within the
707704 HOSPITAL PROVIDER FEE CASH fund, referred to in this19
708705 subsection (5)(c) as the "ARPA account". Notwithstanding any other20
709706 provision of this section to the contrary, money in the ARPA account as21
710707 a result of fund savings and federal matching dollars must be used in22
711708 accordance with section 9817 of the federal "American Rescue Plan Act23
712709 of 2021", Pub.L. 117-2, as amended, referred to in this section as24
713710 "ARPA", to implement or supplement the implementation of home- and25
714711 community-based services under the medical assistance program pursuant26
715712 to the provisions of part 18 of article 6 of this title 25.5.27
716713 270
717714 -22- (II) (C) If the fund savings due to the enhanced federal match1
718715 under ARPA is less than the amount transferred to the ARPA account2
719716 under subsection (5)(c)(II)(A) of this section, then the state department3
720717 shall notify the state treasurer of the amount by which the transfer4
721718 exceeds the savings. The state treasurer shall transfer this amount from5
722719 the ARPA account to the
723720 HOSPITAL PROVIDER FEE CASH fund.6
724721 (III) The state treasurer shall credit all interest and income derived7
725722 from the money in the ARPA account to the
726723 HOSPITAL PROVIDER FEE8
727724 CASH fund.9
728725 (V) Money in the ARPA account remains in the ARPA account10
729726 until the end of the spending period authorized under ARPA, at which11
730727 time money remaining in the ARPA account becomes part of the12
731728 HOSPITAL PROVIDER FEE CASH fund.13
732729 (5.5) Healthcare affordability and sustainability nursing14
733730 facility provider fee cash fund. (a) A
734731 LL HEALTHCARE AFFORDABILITY15
735732 AND SUSTAINABILITY NURSING PROVIDER FEES COLLECTED PURSUANT TO16
736733 THIS SECTION BY THE ENTERPRISE MUST BE TRANSMITTED TO THE STATE17
737734 TREASURER, WHO SHALL CREDIT THE FEE TO THE HEALTHCARE18
738735 AFFORDABILITY AND SUSTAINABILITY NURSING FACILITY PROVIDER FEE19
739736 CASH FUND, WHICH FUND IS CREATED. THE STATE TREASURER SHALL20
740737 CREDIT ALL INTEREST AND INCOME DERIVED FROM THE DEPOSIT AND21
741738 INVESTMENT OF MONEY IN THE NURSING FACILITY PROVIDER FEE CASH22
742739 FUND TO THE NURSING FACILITY PROVIDER FEE CASH FUND . THE STATE23
743740 TREASURER SHALL INVEST ANY MONEY IN THE NURSING FACILITY24
744741 PROVIDER FEE CASH FUND NOT EXPENDED FOR THE PURPOSES SPECIFIED IN25
745742 SUBSECTIONS (4.5)(a) AND (5.5)(b) OF THIS SECTION AS PROVIDED BY LAW.26
746743 M
747744 ONEY IN THE NURSING FACILITY PROVIDER FEE CASH FUND SHALL NOT27
748745 270
749746 -23- BE TRANSFERRED TO ANY OTHER FUND AND SHALL NOT BE USED FOR ANY1
750747 PURPOSE OTHER THAN THE PURPOSES SPECIFIED IN THIS SUBSECTION (5.5)2
751748 AND IN SUBSECTION (4.5)(a) OF THIS SECTION.3
752749 (b) A
753750 LL MONEY IN THE NURSING FACILITY PROVIDER FEE CASH4
754751 FUND IS SUBJECT TO FEDERAL MATCHING AS AUTHORIZED UNDER FEDERAL5
755752 LAW AND, SUBJECT TO ANNUAL APPROPRIATION BY THE GENERAL6
756753 ASSEMBLY, MUST BE EXPENDED BY THE ENTERPRISE FOR THE FOLLOWING7
757754 PURPOSES:8
758755 (I) (A) T
759756 O PAY THE ADMINISTRATIVE COSTS OF IMPLEMENTING9
760757 THIS SUBSECTION (5.5) AND SUBSECTION (4.5) OF THIS SECTION;10
761758 (B) T
762759 O SATISFY SETTLEMENTS OR JUDGMENTS RESULTING FROM11
763760 NURSING FACILITY PROVIDER REIMBURSEMENT APPEALS ; AND12
764761 (C) T
765762 O PAY A NURSING FACILITY PROVIDER A SUPPLEMENTAL13
766763 MEDICAID PAYMENT FOR CARE AND SERVICES RENDERED TO MEDICAID14
767764 RESIDENTS TO OFFSET PAYMENT OF THE NURSING FACILITY PROVIDER FEE .15
768765 T
769766 HE ENTERPRISE, IN CONSULTATION WITH THE STATE DEPARTMENT , SHALL16
770767 COMPUTE THIS PAYMENT ANNUALLY , BEGINNING ON MAY 1, 2025, AND17
771768 EACH JULY 1 THEREAFTER.18
772769 (II) A
773770 FTER THE PAYMENT OF THE AMOUNTS DESCRIBED IN19
774771 SUBSECTION (5.5)(b)(I) OF THIS SECTION, TO PAY THE SUPPLEMENTAL20
775772 MEDICAID PAYMENTS FOR ACUITY OR CASE -MIX OF RESIDENTS21
776773 ESTABLISHED UNDER SECTION 25.5-6-202 (2), PRIOR TO ITS REPEAL ON22
777774 J
778775 ULY 1, 2026, OR AS PROVIDED IN THE RULES ADOPTED BY THE STATE23
779776 BOARD PURSUANT TO SECTION 25.5-6-202 (10) AND (14)(a), IN24
780777 CONSULTATION WITH THE ENTERPRISE AS PROVIDED IN SUBSECTION25
781778 (7)(g)(IV)
782779 OF THIS SECTION;26
783780 (III) A
784781 FTER THE PAYMENT OF THE AMOUNTS DESCRIBED IN27
785782 270
786783 -24- SUBSECTIONS (5.5)(b)(I) AND (5.5)(b)(II) OF THIS SECTION, TO PAY1
787784 SUPPLEMENTAL MEDICAID PAYMENTS BASED UPON PERFORMANCE TO2
788785 THOSE NURSING FACILITY PROVIDERS THAT PROVIDE SERVICES THAT3
789786 RESULT IN BETTER CARE AND HIGHE R QUALITY OF LIFE FOR THEIR4
790787 RESIDENTS. THE ENTERPRISE, IN CONSULTATION WITH THE STATE BOARD ,5
791788 SHALL DETERMINE THE PAYMENT AMOUNT BASED UPON PERFORMANCE6
792789 MEASURES ESTABLISHED IN RULES ADOPTED BY THE STATE BOARD IN THE7
793790 DOMAINS OF QUALITY OF LIFE , QUALITY OF CARE , AND FACILITY8
794791 MANAGEMENT. DURING EACH STATE FISCAL YEAR, THE ENTERPRISE MAY9
795792 DISCONTINUE THE SUPPLEMENTAL MEDICAID PAYMENT ESTABLISHED10
796793 PURSUANT TO THIS SUBSECTION (5.5)(b)(III) TO ANY NURSING FACILITY11
797794 PROVIDER THAT FAILS TO COMPLY WITH THE ESTABLISHED PERFORMANCE12
798795 MEASURES DURING THE STATE FISCAL YEAR , AND THE ENTERPRISE MAY13
799796 INITIATE THE SUPPLEMENTAL MEDICAID PAYMENT ESTABLISHED PURSUANT14
800797 TO THIS SUBSECTION (5.5)(b)(III) TO ANY NURSING FACILITY PROVIDER15
801798 THAT COMES INTO COMPLIANCE WITH THE ESTABLISHED PERFORMANCE16
802799 MEASURES DURING THE STATE FISCAL YEAR .17
803800 (IV) (A) A
804801 FTER THE PAYMENT OF THE AMOUNTS DESCRIBED IN18
805802 SUBSECTIONS (5.5)(b)(I) TO (5.5)(b)(III) OF THIS SECTION, TO PAY THE19
806803 SUPPLEMENTAL MEDICAID PAYMENTS TO NURSING FACILITY PROVIDERS20
807804 THAT SERVE RESIDENTS WHO HAVE MODERATE TO VERY SEVERE MENTAL21
808805 HEALTH CONDITIONS, DEMENTIA DISEASES AND RELATED DISABILITIES, OR22
809806 ACQUIRED BRAIN INJURY. THE ENTERPRISE, IN CONSULTATION WITH THE23
810807 STATE DEPARTMENT , SHALL COMPUTE THIS PAYMENT ANNUALLY ,24
811808 BEGINNING ON MAY 1, 2025, AND EACH JULY 1 THEREAFTER.25
812809 (B) I
813810 F THE ENTERPRISE DETERMINES, IN CONSULTATION WITH THE26
814811 STATE DEPARTMENT, THAT THE CASE-MIX REIMBURSEMENT DESCRIBED IN27
815812 270
816813 -25- SUBSECTION (5.5)(b)(II) OF THIS SECTION INCLUDES A FACTOR FOR1
817814 NURSING FACILITY PROVIDERS THAT SERVE RESIDENTS WITH SEVERE2
818815 DEMENTIA DISEASES AND RELATED DISABILITIES OR ACQUIRED BRAIN3
819816 INJURY, THE ENTERPRISE MAY ELIMINATE THIS SUPPLEMENTAL MEDICAID4
820817 PAYMENT TO THOSE NURSING FACILITY PROVIDERS THAT SERVE RESIDENTS5
821818 WITH SEVERE DEMENTIA DISEASES AND RELATED DISABILITIES OR6
822819 ACQUIRED BRAIN INJURY.7
823820 (V) A
824821 FTER THE PAYMENT OF THE AMOUNTS DESCRIBED IN8
825822 SUBSECTIONS (5.5)(b)(I) TO (5.5)(b)(IV) OF THIS SECTION, TO PAY THE9
826823 SUPPLEMENTAL MEDICAID PAYMENTS FOR THE AMOUNT OF THE10
827824 AGGREGATE STATEWIDE AVERAGE PER DIEM RATE OF PATIENT PAYMENT11
828825 ESTABLISHED UNDER SECTION 25.5-6-202 (9), PRIOR TO ITS REPEAL ON12
829826 J
830827 ULY 1, 2026, OR AS PROVIDED IN THE RULES ADOPTED BY THE STATE13
831828 BOARD PURSUANT TO SECTION 25.5-6-202 (10) AND (14)(a), IN14
832829 CONSULTATION WITH THE ENTERPRISE AS PROVIDED IN SUBSECTION15
833830 (7)(g)(IV)
834831 OF THIS SECTION.16
835832 (5.7) Healthcare affordability and sustainability intermediate17
836833 care facility fee cash fund. (a) A
837834 LL HEALTHCARE AFFORDABILITY AND18
838835 SUSTAINABILITY INTERMEDIATE CARE FACILITY FEES COLLECTED19
839836 PURSUANT TO THIS SECTION BY THE ENTERPRISE MUST BE TRANSMITTED20
840837 TO THE STATE TREASURER , WHO SHALL CREDIT THE FEE TO THE21
841838 HEALTHCARE AFFORDABILITY AND SUSTAINABILITY INTERMEDIATE CARE22
842839 FACILITY FEE CASH FUND , WHICH FUND IS CREATED . THE STATE23
843840 TREASURER SHALL CREDIT ALL INTEREST AND INCOME DERIVED FROM THE24
844841 DEPOSIT AND INVESTMENT OF MONEY IN THE INTERMEDIATE CARE25
845842 FACILITY FEE CASH FUND TO THE INTERMEDIATE CARE FACILITY CASH26
846843 FUND. THE STATE TREASURER SHALL INVEST ANY MONEY IN THE27
847844 270
848845 -26- INTERMEDIATE CARE FACILITY FEE CASH FUND NOT EXPENDED FOR THE1
849846 PURPOSES SPECIFIED IN SUBSECTIONS (4.7)(a) AND (5.7)(b) OF THIS2
850847 SECTION AS PROVIDED BY LAW . MONEY IN THE INTERMEDIATE CARE3
851848 FACILITY FEE CASH FUND SHALL NOT BE TRANSFERRED TO ANY OTHER4
852849 FUND AND SHALL NOT BE USED FOR ANY PURPOSE OTHER THAN THE5
853850 PURPOSES SPECIFIED IN THIS SUBSECTION (5.7) AND IN SUBSECTION (4.7)(a)6
854851 OF THIS SECTION.7
855852 (b) A
856853 LL MONEY IN THE INTERMEDIATE CARE FACILITY FEE CASH8
857854 FUND IS SUBJECT TO FEDERAL MATCHING AS AUTHORIZED UNDER FEDERAL9
858855 LAW AND, SUBJECT TO ANNUAL APPROPRIATION BY THE GENERAL10
859856 ASSEMBLY, MUST BE EXPENDED BY THE ENTERPRISE FOR THE FOLLOWING11
860857 PURPOSES:12
861858 (I) T
862859 O PAY THE ADMINISTRATIVE COSTS OF IMPLEMENTING THIS13
863860 SUBSECTION (5.7) AND SUBSECTION (4.7) OF THIS SECTION; AND14
864861 (II) T
865862 O SUPPLEMENT REIMBURSEMENTS TO INTERMEDIATE CARE15
866863 FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES AS16
867864 PROVIDED IN SECTION 25.5-6-204. THE ENTERPRISE, IN CONSULTATION17
868865 WITH THE STATE DEPARTMENT , SHALL COMPUTE THIS PAYMENT18
869866 ANNUALLY, BEGINNING ON MAY 1, 2025, AND EACH JULY 1 THEREAFTER.19
870867 (6) Appropriations. (a) (I) Except as otherwise provided in20
871868 subsection (6)(b)(I.5) or (6)(b)(I.7) of this section, the healthcare
872869 21
873870 affordability and sustainability HOSPITAL PROVIDER fee is to supplement,22
874871 not supplant, general fund appropriations to support hospital23
875872 reimbursements. General fund appropriations for hospital reimbursements24
876873 shall be maintained at the level of appropriations in the medical services25
877874 premium line item made for the fiscal year commencing July 1, 2008;26
878875 except that general fund appropriations for hospital reimbursements may27
879876 270
880877 -27- be reduced if an index of appropriations to other providers shows that1
881878 general fund appropriations are reduced for other providers. If the index2
882879 shows that general fund appropriations are reduced for other providers,3
883880 the general fund appropriations for hospital reimbursements shall not be4
884881 reduced by a greater percentage than the reductions of appropriations for5
885882 the other providers as shown by the index.6
886883 (IV) E
887884 XCEPT AS OTHERWISE PROVIDED IN SUBSECTION (5.5)(b)(V)7
888885 OF THIS SECTION, THE NURSING FACILITY PROVIDER FEE IS TO SUPPLEMENT,8
889886 NOT SUPPLANT, GENERAL FUND APPROPRIATIONS TO SUPPORT NURSING9
890887 FACILITY PROVIDER REIMBURSEMENTS .10
891888 (V) E
892889 XCEPT AS OTHERWISE PROVIDED IN SUBSECTION (5.7)(b)(II)11
893890 OF THIS SECTION, THE INTERMEDIATE CARE FACILITY FEE IS TO12
894891 SUPPLEMENT, NOT SUPPLANT, GENERAL FUND APPROPRIATIONS TO13
895892 SUPPORT INTERMEDIATE CARE FACILITY REIMBURSEMENTS .14
896893 (b) If the revenue from the healthcare affordability and
897894 15
898895 sustainability HOSPITAL PROVIDER fee is insufficient to fully fund all of16
899896 the purposes described in subsection (5)(b) of this section:17
900897 (II) The hospital provider reimbursement and quality incentive18
901898 payment increases described in subsections (5)(b)(I) to (5)(b)(III) of this19
902899 section and the costs described in subsection (5)(b)(VI) of this section20
903900 shall be fully funded using revenue from the healthcare affordability and21
904901 sustainability HOSPITAL PROVIDER fee and federal matching funds before22
905902 any eligibility expansion is funded; and23
906903 (III) (A) If the state board promulgates rules that expand eligibility24
907904 for medical assistance to be paid for pursuant to subsection (5)(b)(IV) of25
908905 this section, and the state department thereafter notifies the enterprise26
909906 board that the revenue available from the healthcare affordability and27
910907 270
911908 -28- sustainability HOSPITAL PROVIDER fee and the federal matching funds will1
912909 not be sufficient to pay for all or part of the expanded eligibility, the2
913910 enterprise board shall recommend to the state board reductions in medical3
914911 benefits or eligibility so that the revenue will be sufficient to pay for all4
915912 of the reduced benefits or eligibility. After receiving the5
916913 recommendations of the enterprise board, the state board shall adopt rules6
917914 providing for reduced benefits or reduced eligibility for which the7
918915 revenue will be sufficient and shall forward any adopted rules to the joint8
919916 budget committee. Notwithstanding the provisions of section 24-4-1039
920917 (8) and (12), following the adoption of rules pursuant to this subsection10
921918 (6)(b)(III)(A), the state board shall not submit the rules to the attorney11
922919 general and shall not file the rules with the secretary of state until the joint12
923920 budget committee approves the rules pursuant to subsection (6)(b)(III)(B)13
924921 of this section.14
925922 (B) The joint budget committee shall promptly consider any rules15
926923 adopted by the state board pursuant to subsection (6)(b)(III)(A) of this16
927924 section. The joint budget committee shall promptly notify the state17
928925 department, the state board, and the enterprise board of any action on the18
929926 rules. If the joint budget committee does not approve the rules, the joint19
930927 budget committee shall recommend a reduction in benefits or eligibility20
931928 so that the revenue from the healthcare affordability and sustainability21
932929 HOSPITAL PROVIDER fee and the matching federal funds will be sufficient22
933930 to pay for the reduced benefits or eligibility. After approving the rules23
934931 pursuant to this subsection (6)(b)(III)(B), the joint budget committee shall24
935932 request that the committee on legal services, created pursuant to section25
936933 2-3-501, extend the rules as provided for in section 24-4-103 (8) unless26
937934 the committee on legal services finds after review that the rules do not27
938935 270
939936 -29- conform with section 24-4-103 (8)(a).1
940937 (b.5) I
941938 F THE REVENUE FROM THE NURSING FACILITY PROVIDER FEE2
942939 IS INSUFFICIENT TO FULLY FUND ALL OF THE PURPOSES DESCRIBED IN3
943940 SUBSECTION (5.5)(b) OF THIS SECTION:4
944941 (I) T
945942 HE GENERAL ASSEMBLY IS NOT OBLIGATED TO APPROPRIATE5
946943 GENERAL FUND REVENUES TO FUND SUCH PURPOSES ; AND6
947944 (II) S
948945 UBJECT TO THE PRIORITY OF THE USES FOR THE NURSING7
949946 FACILITY PROVIDER FEE AS PROVIDED IN SUBSECTION (5.5)(b) OF THIS8
950947 SECTION, THE ENTERPRISE, IN CONSULTATION WITH THE STATE9
951948 DEPARTMENT, MAY SUSPEND OR REDUCE ANY SUPPLEMENTAL MEDICAID10
952949 PAYMENT.11
953950 (c) Notwithstanding any other provision of this section, if, after12
954951 receipt of authorization to receive federal matching funds for money in13
955952 the
956953 HOSPITAL PROVIDER FEE CASH fund, the authorization is withdrawn or14
957954 changed so that federal matching funds are no longer available, the15
958955 enterprise shall cease collecting the healthcare affordability and
959956 16
960957 sustainability HOSPITAL PROVIDER fee and shall repay to the hospitals any17
961958 money received by the
962959 HOSPITAL PROVIDER FEE CASH fund that is not18
963960 subject to federal matching funds.19
964961 (c.5) N
965962 OTWITHSTANDING ANY OTHER PROVISION OF THIS SECTION ,20
966963 IF, AFTER RECEIPT OF AUTHORIZATION TO RECEIVE FEDERAL MATCHING21
967964 FUNDS FOR MONEY IN THE NURSING FACILITY PROVIDER FEE CASH FUND ,22
968965 THE AUTHORIZATION IS WITHDRAWN OR CHANGED SO THAT FEDERAL23
969966 MATCHING FUNDS ARE NO LONGER AVAILABLE , THE ENTERPRISE SHALL24
970967 CEASE COLLECTING THE NURSING FACILITY PROVIDER FEE AND SHALL25
971968 REPAY TO THE NURSING FACILITY PROVIDERS ANY MONEY RECEIVED IN26
972969 THE NURSING FACILITY PROVIDER FEE CASH FUND THAT IS NOT SUBJECT TO27
973970 270
974971 -30- FEDERAL MATCHING FUNDS .1
975972 (c.7) N
976973 OTWITHSTANDING ANY OTHER PROVISION OF THIS SECTION ,2
977974 IF, AFTER RECEIPT OF AUTHORIZATION TO RECEIVE FEDERAL MATCHING3
978975 FUNDS FOR MONEY IN THE INTERMEDIATE CARE FACILITY FEE CASH FUND ,4
979976 THE AUTHORIZATION IS WITHDRAWN OR CHANGED SO THAT FEDERAL5
980977 MATCHING FUNDS ARE NO LONGER AVAILABLE , THE ENTERPRISE SHALL6
981978 CEASE COLLECTING THE INTERMEDIATE CARE FACILITY FEE AND SHALL7
982979 REPAY TO THE INTERMEDIATE CARE FACILITIES ANY MONEY RECEIVED IN8
983980 THE INTERMEDIATE CARE FACILITY FEE CASH FUND THAT IS NOT SUBJECT9
984981 TO FEDERAL MATCHING FUNDS .10
985982 (7) Colorado healthcare affordability and sustainability11
986983 enterprise board. (b) Members of the enterprise board serve without12
987984 compensation but must be reimbursed from money in the
988985 HOSPITAL13
989986 PROVIDER FEE CASH fund for actual and necessary expenses incurred in14
990987 the performance of their duties pursuant to this section.15
991988 (d) The enterprise board has, at a minimum, the following duties:16
992989 (I) To determine the timing and method by which the enterprise17
993990 assesses the healthcare affordability and sustainability
994991 HOSPITAL18
995992 PROVIDER fee and the amount of the fee;19
996993 (II) If requested by the health and human services committee of20
997994 the senate or the public health care and human services committee of the21
998995 house of representatives, or any successor committees, to consult with the22
999996 committees on any legislation that may impact the healthcare affordability23
1000997 and sustainability fee FEES, PAYMENTS, or hospital reimbursements24
1001998 established pursuant to this section; 25
1002999 (III) To determine changes in the healthcare affordability and26
10031000 sustainability HOSPITAL PROVIDER fee that increase the number of27
10041001 270
10051002 -31- hospitals benefitting from the uses of the healthcare affordability and1
10061003 sustainability fee described in subsections (5)(b)(I) to (5)(b)(IV) of this2
10071004 section or that minimize the number of hospitals that suffer losses as a3
10081005 result of paying the healthcare affordability and sustainability HOSPITAL4
10091006 PROVIDER fee;5
10101007 (IX) To monitor the impact of the healthcare affordability and6
10111008 sustainability HOSPITAL PROVIDER fee, THE NURSING FACILITY PROVIDER7
10121009 FEE, AND THE INTERMEDIATE CARE FACILITY FEE on the broader8
10131010 health-care marketplace;9
10141011 (X) To establish requirements for the reports that hospitals must10
10151012 submit to the enterprise to allow the enterprise to calculate the amount of11
10161013 the healthcare affordability and sustainability HOSPITAL PROVIDER fee;12
10171014 and13
10181015 (e) On or before January 15, 2018, and on or before January 1514
10191016 each year thereafter, the enterprise board shall submit a written report to15
10201017 the health and human services committee of the senate and the public16
10211018 health care and human services committee of the house of representatives,17
10221019 or any successor committees, the joint budget committee of the general18
10231020 assembly, the governor, and the state board. The report shall include, but19
10241021 need not be limited to:20
10251022 (II) A description of the formula for how the healthcare21
10261023 affordability and sustainability HOSPITAL PROVIDER fee is calculated and22
10271024 the process by which the healthcare affordability and sustainability fee is23
10281025 assessed and collected;24
10291026 (II.5) A
10301027 DESCRIPTION OF THE FORMULA FOR HOW THE NURSING25
10311028 FACILITY PROVIDER FEE IS CALCULATED AND THE PROCESS BY WHICH THE26
10321029 FEE IS ASSESSED AND COLLECTED;27
10331030 270
10341031 -32- (II.7) A DESCRIPTION OF THE FORMULA FOR HOW THE1
10351032 INTERMEDIATE CARE FACILITY FEE IS CALCULATED AND THE PROCESS BY2
10361033 WHICH THE FEE IS ASSESSED AND COLLECTED ;3
10371034 (III) An itemization of the total amount of the healthcare4
10381035 affordability and sustainability HOSPITAL PROVIDER fee paid by each5
10391036 hospital and any projected revenue that each hospital is expected to6
10401037 receive due to:7
10411038 (III.5) A
10421039 N ITEMIZATION OF THE TOTAL AMOUNT OF THE NURSING8
10431040 FACILITY PROVIDER FEE PAID BY EACH NURSING FACILITY PROVIDER AND9
10441041 ANY PROJECTED REVENUE THAT EACH NURSING FACILITY PROVIDER IS10
10451042 EXPECTED TO RECEIVE DUE TO INCREASED REIMBURSEMENTS AND11
10461043 SUPPLEMENTAL PAYMENTS MADE PURSUANT TO SUBSECTION (5.5)(b) OF12
10471044 THIS SECTION;13
10481045 (III.7) A
10491046 N ITEMIZATION OF THE TOTAL AMOUNT OF THE14
10501047 INTERMEDIATE CARE FACILITY FEE PAID BY EACH INTERMEDIATE CARE15
10511048 FACILITY FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES AND ANY16
10521049 PROJECTED REVENUE THAT EACH INTERMEDIATE CARE FACILITY IS17
10531050 EXPECTED TO RECEIVE DUE TO INCREASED REIMBURSEMENTS MADE18
10541051 PURSUANT TO SUBSECTION (5.7)(b) OF THIS SECTION;19
10551052 (IV) An itemization of the costs incurred by the enterprise in20
10561053 implementing and administering the healthcare affordability and
10571054 21
10581055 sustainability HOSPITAL PROVIDER fee, THE NURSING FACILITY PROVIDER22
10591056 FEE, AND THE INTERMEDIATE CARE FACILITY FEE ;23
10601057 (g) (I) T
10611058 HE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD24
10621059 IS CREATED WITHIN THE ENTERPRISE FOR THE PURPOSE OF SUPPORTING THE25
10631060 ENTERPRISE BOARD WITH THE IMPLEMENTATION OF THE NURSING FACILITY26
10641061 PROVIDER FEE AND THE INTERMEDIATE CARE FACILITY FEE . THE FACILITY27
10651062 270
10661063 -33- PROVIDER FEE ENTERPRISE SUPPORT BOARD CONSISTS OF EIGHT MEMBERS1
10671064 APPOINTED BY THE GOVERNOR , WITH THE ADVICE AND CONSENT OF THE2
10681065 SENATE, AS FOLLOWS:3
10691066 (A) T
10701067 WO MEMBERS WHO ARE REPRESENTATIVES OF NURSING4
10711068 FACILITY ASSOCIATIONS;5
10721069 (B) T
10731070 WO MEMBERS WHO ARE REPRESENTATIVES OF NURSING6
10741071 FACILITIES, WITH ONE MEMBER REPRESENTING A RURAL NURSING7
10751072 FACILITY;8
10761073 (C) O
10771074 NE MEMBER WHO IS A RESIDENT OF A LONG -TERM CARE9
10781075 FACILITY OR A CONSUMER OF LONG -TERM CARE SERVICES, OR A FAMILY10
10791076 MEMBER OR GUARDIAN REPRESENTING SUCH RESIDENT OR CONSUMER ;11
10801077 (D) O
10811078 NE EMPLOYEE OF THE STATE DEPARTMENT ;12
10821079 (E) O
10831080 NE EMPLOYEE OF THE DEPARTMENT OF HUMAN SERVICES13
10841081 CREATED IN SECTION 24-1-120; AND14
10851082 (F) O
10861083 NE EMPLOYEE OF THE DEPARTMENT OF PUBLIC HEALTH AND15
10871084 ENVIRONMENT CREATED IN SECTION 25-1-102.16
10881085 (II) (A) M
10891086 EMBERS OF THE FACILITY PROVIDER FEE ENTERPRISE17
10901087 SUPPORT BOARD SERVE AT THE PLEASURE OF THE GOVERNOR . ALL TERMS18
10911088 ARE FOR FOUR YEARS. A MEMBER WHO IS APPOINTED TO FILL A VACANCY19
10921089 SHALL SERVE THE REMAINDER OF THE UNEXPIRED TERM OF THE FORMER20
10931090 MEMBER.21
10941091 (B) T
10951092 HE GOVERNOR SHALL MAKE THE INITIAL APPOINTMENTS TO22
10961093 THE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD AS SOON AS23
10971094 PRACTICAL FOLLOWING MAY 1, 2025.24
10981095 (III) T
10991096 HE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD25
11001097 SHALL ELECT A CHAIR AND A VICE-CHAIR FROM AMONG ITS MEMBERS .26
11011098 (IV)
11021099 THE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD27
11031100 270
11041101 -34- SHALL FULFILL, AT A MINIMUM, THE FOLLOWING DUTIES ON BEHALF OF THE1
11051102 ENTERPRISE:2
11061103 (A) T
11071104 O DETERMINE THE TIMING AND METHOD BY WHICH THE3
11081105 ENTERPRISE ASSESSES THE NURSING FACILITY PROVIDER FEE AND THE4
11091106 INTERMEDIATE CARE FACILITY FEE AND THE AMOUNTS OF THE FEES ;5
11101107 (B) T
11111108 O DETERMINE CHANGES IN THE NURSING FACILITY PROVIDER6
11121109 FEE THAT INCREASE THE NUMBER OF NURSING FACILITY PROVIDERS7
11131110 BENEFITTING FROM THE USES OF THE FEE DESCRIBED IN SUBSECTION8
11141111 (5.5)(b)
11151112 OF THIS SECTION OR THAT MINIMIZE THE NUMBER OF NURSING9
11161113 FACILITY PROVIDERS THAT SUFFER LOSSES AS A RESULT OF PAYING THE10
11171114 NURSING FACILITY PROVIDER FEE;11
11181115 (C) T
11191116 O DETERMINE CHANGES IN THE INTERMEDIATE CARE FACILITY12
11201117 FEE THAT INCREASE THE NUMBER OF INTERMEDIATE CARE FACILITIES FOR13
11211118 INDIVIDUALS WITH INTELLECTUAL DISABILITIES THAT BENEFIT FROM THE14
11221119 USES OF THE FEE DESCRIBED IN SUBSECTION (5.7)(b) OF THIS SECTION OR15
11231120 THAT MINIMIZE THE NUMBER OF INTERMEDIATE CARE FACILITIES FOR16
11241121 INDIVIDUALS WITH INTELLECTUAL DISABILITIES THAT SUFFER LOSSES AS17
11251122 A RESULT OF PAYING THE NURSING FACILITY PROVIDER FEE ;18
11261123 (D) T
11271124 O CONSULT WITH THE STATE BOARD ON THE RULES19
11281125 REGARDING PAYMENTS TO NURSING FACILITY PROVIDERS THAT IT ADOPTS20
11291126 PURSUANT TO SECTION 25.5-6-202 (10) AND (14)(a);21
11301127 (E) T
11311128 O CONSULT WITH THE STATE BOARD AND THE STATE22
11321129 DEPARTMENT ON THE RULES , PRICE SCHEDULES, AND ALLOWANCES23
11331130 REGARDING REIMBURSEMENT AND PAYMENTS TO INTERMEDIATE CARE24
11341131 FACILITIES THAT THEY ADOPT PURSUANT TO SECTION 25.5-6-204;25
11351132 (F) T
11361133 O ESTABLISH REQUIREMENTS FOR THE REPORTS THAT26
11371134 NURSING FACILITY PROVIDERS MUST SUBMIT TO THE ENTERPRISE TO27
11381135 270
11391136 -35- ALLOW THE ENTERPRISE TO CALCULATE THE AMOUNT OF THE NURSING1
11401137 FACILITY PROVIDER FEE; AND2
11411138 (G) T
11421139 O ESTABLISH REQUIREMENTS FOR THE REPORTS THAT3
11431140 INTERMEDIATE CARE FACILITIES MUST SUBMIT TO THE ENTERPRISE TO4
11441141 ALLOW THE ENTERPRISE TO CALCULATE THE AMOUNT OF THE5
11451142 INTERMEDIATE CARE FACILITY FEE.6
11461143 (V) M
11471144 EMBERS OF THE FACILITY PROVIDER FEE ENTERPRISE7
11481145 SUPPORT BOARD SERVE WITHOUT COMPENSATION BUT MUST BE8
11491146 REIMBURSED FROM MONEY IN THE NURSING FACILITY PROVIDER FEE CASH9
11501147 FUND OR THE INTERMEDIATE CARE FACILITY FEE CASH FUND FOR ACTUAL10
11511148 AND NECESSARY EXPENSES INCURRED IN THE PERFORMANCE OF THEIR11
11521149 DUTIES PURSUANT TO THIS SECTION.12
11531150 (7.5) Enterprise transparency and reporting. TO ENSURE13
11541151 TRANSPARENCY AND ACCOUNTABILITY, AND IN ADDITION TO THE REPORT14
11551152 REQUIRED BY SUBSECTION (7)(e) OF THIS SECTION, THE ENTERPRISE15
11561153 SHALL:16
11571154 (a) NO LATER THAN NOVEMBER 1, 2025, AND BY NOVEMBER 1 OF17
11581155 EACH THREE-YEAR PERIOD THEREAFTER, PUBLISH AND POST ON ITS18
11591156 WEBSITE A THREE-YEAR PLAN THAT DETAILS HOW THE ENTERPRISE WILL19
11601157 EXECUTE ITS BUSINESS PURPOSES DURING THE CURRENT STATE FISCAL20
11611158 YEAR AND THE TWO SUBSEQUENT STATE FISCAL YEARS AND THAT21
11621159 ESTIMATES THE AMOUNT OF FUNDING NEEDED TO IMPLEMENT THE PLAN ;22
11631160 AND23
11641161 (b) CREATE, MAINTAIN, AND REGULARLY UPDATE ON ITS WEBSITE24
11651162 A PUBLIC ACCOUNTABILITY DASHBOARD THAT PROVIDES, AT A MINIMUM,25
11661163 ACCESSIBLE AND TRANSPARENT SUMMARY INFORMATION REGARDING THE26
11671164 IMPLEMENTATION OF ITS THREE-YEAR PLAN, THE FUNDING STATUS AND27
11681165 270
11691166 -36- PROGRESS TOWARD COMPLETION OF EACH PROJECT THAT IT WHOLLY OR1
11701167 PARTLY FUNDS, AND ITS PER-PROJECT AND TOTAL FUNDING AND2
11711168 EXPENDITURES.3
11721169 (9) Definitions. A
11731170 S USED IN THIS SECTION, UNLESS THE CONTEXT4
11741171 OTHERWISE REQUIRES:5
11751172 (a) "C
11761173 ASE-MIX" HAS THE SAME MEANING AS SET FORTH IN SECTION6
11771174 25.5-6-201
11781175 (8).7
11791176 (b) "C
11801177 ASE-MIX REIMBURSEMENT" HAS THE SAME MEANING AS SET8
11811178 FORTH IN SECTION 25.5-6-201 (12).9
11821179 (c) "C
11831180 OLORADO HEALTHCARE AFFORDABILITY AND10
11841181 SUSTAINABILITY ENTERPRISE" OR "ENTERPRISE" MEANS THE ENTERPRISE11
11851182 CREATED IN SUBSECTION (3) OF THIS SECTION.12
11861183 (d) "F
11871184 ACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD " MEANS13
11881185 THE FACILITY PROVIDER FEE ENTERPRISE SUPPORT BOARD CREATED IN14
11891186 SUBSECTION (7)(g) OF THIS SECTION.15
11901187 (e) "H
11911188 EALTHCARE AFFORDABILITY AND SUSTAINABILITY HOSPITAL16
11921189 PROVIDER FEE" OR "HOSPITAL PROVIDER FEE" MEANS THE HEALTHCARE17
11931190 AFFORDABILITY AND SUSTAINABILITY HOSPITAL PROVIDER FEE CHARGED18
11941191 AND COLLECTED AS AUTHORIZED BY SUBSECTION (4) OF THIS SECTION.19
11951192 (f) "H
11961193 EALTHCARE AFFORDABILITY AND SUSTAINABILITY HOSPITAL20
11971194 PROVIDER FEE CASH FUND" OR "HOSPITAL PROVIDER FEE CASH FUND "21
11981195 MEANS THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITY HOSPITAL22
11991196 PROVIDER FEE CASH FUND CREATED IN SUBSECTION (5) OF THIS SECTION.23
12001197 (g) "H
12011198 EALTHCARE AFFORDABILITY AND SUSTAINABILITY24
12021199 INTERMEDIATE CARE FACILITY FEE" OR "INTERMEDIATE CARE FACILITY25
12031200 FEE" MEANS THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITY26
12041201 INTERMEDIATE CARE FACILITY FEE FOR INTERMEDIATE CARE FACILITIES27
12051202 270
12061203 -37- FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES CHARGED AND1
12071204 COLLECTED AS AUTHORIZED BY SUBSECTION (4.7) OF THIS SECTION.2
12081205 (h) "H
12091206 EALTHCARE AFFORDABILITY AND SUSTAINABILITY3
12101207 INTERMEDIATE CARE FACILITY FEE CASH FUND " OR "INTERMEDIATE CARE4
12111208 FACILITY FEE CASH FUND" MEANS THE HEALTHCARE AFFORDABILITY AND5
12121209 SUSTAINABILITY INTERMEDIATE CARE FACILITY FEE CASH FUND CREATED6
12131210 IN SUBSECTION (5.7) OF THIS SECTION.7
12141211 (i) "H
12151212 EALTHCARE AFFORDABILITY AND SUSTAINABILITY NURSING8
12161213 FACILITY PROVIDER FEE" OR "NURSING FACILITY PROVIDER FEE" MEANS9
12171214 THE HEALTHCARE AFFORDABILITY AND SUSTAINABILITY NURSING FACILITY10
12181215 PROVIDER FEE CHARGED AND COLLECTED AS AUTHORIZED BY SUBSECTION11
12191216 (4.5)
12201217 OF THIS SECTION.12
12211218 (j) "H
12221219 EALTHCARE AFFORDABILITY AND SUSTAINABILITY NURSING13
12231220 FACILITY PROVIDER FEE CASH FUND" OR "NURSING FACILITY PROVIDER FEE14
12241221 CASH FUND" MEANS THE HEALTHCARE AFFORDABILITY AND15
12251222 SUSTAINABILITY NURSING FACILITY PROVIDER FEE CASH FUND CREATED IN16
12261223 SUBSECTION (5.5) OF THIS SECTION.17
12271224 (k) "H
12281225 OSPITAL" MEANS A LICENSED OR CERTIFIED HOSPITAL.18
12291226 (l) "N
12301227 URSING FACILITY PROVIDER" HAS THE SAME MEANING AS SET19
12311228 FORTH IN SECTION 25.5-6-201 (25).20
12321229 (m) "S
12331230 TATE MEDICAL ASSISTANCE PROGRAM " MEANS THE21
12341231 PROGRAM DESCRIBED IN THIS ARTICLE 4 AND ARTICLES 5 AND 6 OF THIS22
12351232 TITLE 25.5.23
12361233 (n) "S
12371234 TATEWIDE AVERAGE PER DIEM RATE " HAS THE SAME24
12381235 MEANING AS SET FORTH IN SECTION 25.5-6-201 (35).25
12391236 (o) "S
12401237 UPPLEMENTAL MEDICAID PAYMENT " HAS THE SAME MEANING26
12411238 AS SET FORTH IN SECTION 25.5-6-201 (36).27
12421239 270
12431240 -38- SECTION 2. In Colorado Revised Statutes, 25.5-4-402.4, amend1
12441241 (2) introductory portion and (2)(d) introductory portion; and amend as2
12451242 they will become effective July 1, 2025, (2)(d)(I), (4)(a) introductory3
12461243 portion, and (4)(g)(I) as follows:4
12471244 25.5-4-402.4. Healthcare affordability and sustainability5
12481245 hospital provider fee - healthcare affordability and sustainability6
12491246 nursing facility provider fee - healthcare affordability and7
12501247 sustainability intermediate care facility fee - Colorado healthcare8
12511248 affordability and sustainability enterprise - federal waiver - funds9
12521249 created - reports - rules - legislative declaration - repeal.10
12531250 (2) Legislative declaration. The general assembly hereby finds and11
12541251 declares that:12
12551252 (d) The Colorado healthcare affordability and sustainability13
12561253 enterprise provides business services to hospitals when, in exchange for14
12571254 payment of healthcare affordability and sustainability
12581255 HOSPITAL PROVIDER15
12591256 fees by hospitals, it:16
12601257 (I) Obtains federal matching money and returns both the17
12611258 healthcare affordability and sustainability
12621259 HOSPITAL PROVIDER fee and the18
12631260 federal matching money to hospitals to increase reimbursement rates to19
12641261 hospitals for providing medical care under the state medical assistance20
12651262 program, including disproportionate share hospital payments pursuant to21
12661263 42 U.S.C. sec. 1396r-4, and to increase the number of individuals covered22
12671264 by public medical assistance; and23
12681265 (4) Healthcare affordability and sustainability fee. (a) For the24
12691266 fiscal year commencing July 1, 2017, and for each fiscal year thereafter,25
12701267 the enterprise is authorized to charge and collect a healthcare affordability26
12711268 and sustainability
12721269 HOSPITAL PROVIDER fee, as described in 42 CFR 433.6827
12731270 270
12741271 -39- (b), on outpatient and inpatient services provided by all licensed or1
12751272 certified hospitals referred to in this section as "hospitals", for the purpose2
12761273 of obtaining federal financial participation under the state medical3
12771274 assistance program as described in this article 4 and articles 5 and 6 of4
12781275 this title 25.5, referred to in this section as the "state medical assistance5
12791276 program", including disproportionate share hospital payments pursuant6
12801277 to 42 U.S.C. sec. 1396r-4. If the amount of healthcare affordability and7
12811278 sustainability HOSPITAL PROVIDER fee revenue collected exceeds the8
12821279 federal net patient revenue-based limit on the amount of such fee revenue9
12831280 that may be collected, requiring repayment to the federal government of10
12841281 excess federal matching money received, hospitals that received such11
12851282 excess federal matching money are responsible for repaying the excess12
12861283 federal money and any associated federal penalties to the federal13
12871284 government. The enterprise shall use the healthcare affordability and14
12881285 sustainability HOSPITAL PROVIDER fee revenue to:15
12891286 (g) (I) The state board shall promulgate any rules pursuant to the16
12901287 "State Administrative Procedure Act", article 4 of title 24, necessary for17
12911288 the administration and implementation of this section. Prior to submitting18
12921289 any proposed rules concerning the administration or implementation of19
12931290 the healthcare affordability and sustainability HOSPITAL PROVIDER fee to20
12941291 the state board, the enterprise shall consult with the state board on the21
12951292 proposed rules as specified in subsection (7)(d) of this section.22
12961293 SECTION 3. In Colorado Revised Statutes, 25.5-5-103, amend23
12971294 (1)(b) as follows:24
12981295 25.5-5-103. Mandated programs with special state provisions25
12991296 - rules. (1) This section specifies programs developed by Colorado to26
13001297 meet federal mandates. These programs include but are not limited to:27
13011298 270
13021299 -40- (b) Special provisions relating to nursing facilities, as specified in1
13031300 sections 25.5-6-201 to 25.5-6-203, 25.5-6-205, and 25.5-6-206 SECTIONS2
13041301 25.5-4-402.4
13051302 (4.5) AND (5.5), 25.5-6-201, 25.5-6-202, 25.5-6-205, AND3
13061303 25.5-6-206;4
13071304 SECTION 4. In Colorado Revised Statutes, 25.5-6-202, amend5
13081305 (9)(b)(I) introductory portion, (9)(b)(II), and (9)(b)(VI); and repeal (5),6
13091306 (6), (7), (9)(b.3), and (9)(d) as follows:7
13101307 25.5-6-202. Providers - nursing facility provider8
13111308 reimbursement - exemption - rules - repeal. (5) Subject to available
13121309 9
13131310 appropriations and the priority of the uses of the provider fees as10
13141311 established in section 25.5-6-203 (2)(b), in addition to the reimbursement11
13151312 rate components paid pursuant to subsections (1) to (4) of this section, the12
13161313 state department shall make a supplemental medicaid payment based13
13171314 upon performance to those nursing facility providers that provide services14
13181315 that result in better care and higher quality of life for their residents. The15
13191316 state department shall determine the payment amount based upon16
13201317 performance measures established in rules adopted by the state board in17
13211318 the domains of quality of life, quality of care, and facility management.18
13221319 Beginning July 1, 2024, the payment must not be less than twelve percent19
13231320 of total provider fee payments and must be adjusted for fiscal years20
13241321 2024-25 and 2025-26. No later than July 1, 2026, the payment must not21
13251322 be less than fifteen percent of total provider fee payments and must be22
13261323 annually adjusted thereafter. During each state fiscal year, the state23
13271324 department may discontinue the supplemental medicaid payment24
13281325 established pursuant to this subsection (5) to any nursing facility provider25
13291326 that fails to comply with the established performance measures during the26
13301327 state fiscal year, and the state department may initiate the supplemental27
13311328 270
13321329 -41- medicaid payment established pursuant to this subsection (5) to any1
13331330 provider that comes into compliance with the established performance2
13341331 measures during the state fiscal year.3
13351332 (6) Subject to available appropriations and the priority of the uses4
13361333 of the provider fees as established in section 25.5-6-203 (2)(b), in5
13371334 addition to the reimbursement rate components paid pursuant to6
13381335 subsections (1) to (5) of this section, the state department shall make a7
13391336 supplemental medicaid payment to nursing facility providers that serve8
13401337 residents:9
13411338 (a) Who have severe mental health conditions that are classified10
13421339 at a level II by the medicaid program's preadmission screening and11
13431340 resident review assessment tool. The state department shall compute this12
13441341 payment annually as of July 1, 2009, and each July 1 thereafter, and it13
13451342 must not be less than two percent of the statewide average per diem rate14
13461343 for the combined rate components determined pursuant to subsections (1)15
13471344 to (4) of this section. Beginning July 1, 2023, the state department shall16
13481345 annually adjust the rate to ensure access to care for residents who have17
13491346 severe mental health conditions.18
13501347 (b) With severe dementia diseases and related disabilities or19
13511348 acquired brain injury. The state department shall calculate the payment20
13521349 based upon the resident's cognitive assessment established in rules21
13531350 adopted by the state board. The state department shall compute this22
13541351 payment annually as of July 1, 2009, and each July 1 thereafter, and it23
13551352 must not be less than one percent of the statewide average per diem rate24
13561353 for the combined rate components determined pursuant to subsections (1)25
13571354 to (4) of this section. Beginning July 1, 2023, the state department shall26
13581355 annually adjust the rate to ensure access to care for residents with severe27
13591356 270
13601357 -42- dementia diseases and related disabilities or acquired brain injury.1
13611358 (7) Subject to available moneys and the priority of the uses of the2
13621359 provider fees as established in section 25.5-6-203 (2)(b), in addition to the3
13631360 reimbursement rate components paid pursuant to subsections (1) to (6) of4
13641361 this section, the state department shall pay a nursing facility provider a5
13651362 supplemental medicaid payment for care and services rendered to6
13661363 medicaid residents to offset payment of the provider fee assessed under7
13671364 the provisions of section 25.5-6-203. The state department shall compute8
13681365 this payment annually, as of July 1, 2009, and each July 1 thereafter.9
13691366 (9) (b) (I) Except for changes in the number of patient days, the10
13701367 state department shall establish the general fund share of the aggregate11
13711368 statewide average of the per diem rate net of patient payment pursuant to12
13721369 subsections (1) to (4) of this section. The state's share of the13
13731370 reimbursement rate components pursuant to subsections (1) to (4) of this14
13741371 section may be funded through the provider fee assessed pursuant to15
13751372 section 25.5-6-203 SECTION 25.5-4-402.4 (4.5) and any associated federal16
13761373 funds. Any provider fee used as the state's share and all federal funds17
13771374 must be excluded from the calculation of the general fund share. For the18
13781375 fiscal year commencing July 1, 2009, and for each fiscal year thereafter,19
13791376 the state department shall calculate the general fund share of the20
13801377 aggregate statewide average per diem rate net of patient payment pursuant21
13811378 to subsections (1) to (4) of this section using the rates that were effective22
13821379 on July 1 of that fiscal year; except that:23
13831380 (II) If the aggregate statewide average per diem rate net of patient24
13841381 payment pursuant to subsections (1) to (4) of this section exceeds the25
13851382 general fund share, the amount of the average statewide per diem rate that26
13861383 exceeds the general fund share shall MUST be paid as a supplemental27
13871384 270
13881385 -43- medicaid payment using the provider fee established under section1
13891386 25.5-6-203 SECTION 25.5-4-402.4 (4.5). Subject to the priority of the uses2
13901387 of the provider fee established under section 25.5-6-203 (2)(b) SECTION3
13911388 25.5-4-402.4 (5.5)(b), if the provider fee is insufficient to fully fund the4
13921389 supplemental medicaid payment, the supplemental medicaid payment5
13931390 shall MUST be reduced to all providers proportionately.6
13941391 (VI) Notwithstanding any other provision of law, for the fiscal7
13951392 year commencing July 1, 2013, and each fiscal year thereafter, the general8
13961393 fund portion of the per diem rate pursuant to subsections (1) to (4) of this9
13971394 section shall be reduced by one and one-half percent. The state10
13981395 department may, but is not required to, increase the supplemental11
13991396 medicaid payment pursuant to subparagraph (II) of this paragraph (b)12
14001397 SUBSECTION (9)(b)(II) OF THIS SECTION due to this reduction. except that13
14011398 the provider fee shall not exceed the amount specified in section14
14021399 25.5-6-203 (1)(a)(II).15
14031400 (b.3) (I) For the fiscal year commencing July 1, 2009, and for each16
14041401 fiscal year thereafter, if the provider fee established under section17
14051402 25.5-6-203 is insufficient to fully fund the supplemental medicaid18
14061403 payments established under subsections (5) to (7) of this section, subject19
14071404 to the priority of the uses of the provider fee established pursuant to20
14081405 section 25.5-6-203 (2)(b), the state department may suspend or reduce the21
14091406 supplemental medicaid payment subject to the uses of the provider fee22
14101407 established under section 25.5-6-203.23
14111408 (II) If it is determined by the state department that the case-mix24
14121409 reimbursement includes a factor for nursing facility providers that serve25
14131410 residents with severe dementia diseases and related disabilities or26
14141411 acquired brain injury, the state department may eliminate the27
14151412 270
14161413 -44- supplemental medicaid payment to those providers that serve residents1
14171414 with severe dementia diseases and related disabilities or acquired brain2
14181415 injury.3
14191416 (d) The reimbursement rate components pursuant to subsections4
14201417 (5) to (7) of this section shall be funded entirely through the provider fee5
14211418 assessed pursuant to the provisions of section 25.5-6-203 and any6
14221419 associated federal funds. No general fund moneys shall be used to pay for7
14231420 the reimbursement rate components established pursuant to subsections8
14241421 (5) to (7) of this section.9
14251422 SECTION 5. In Colorado Revised Statutes, 25.5-6-203, repeal10
14261423 (1); and add (2)(a.5) and (3) as follows:11
14271424 25.5-6-203. Nursing facilities - provider fees - federal waiver12
14281425 - fund created - rules - repeal. (1) (a) (I) Beginning with the fiscal year13
14291426 commencing July 1, 2008, and each fiscal year thereafter, the state14
14301427 department shall charge and collect provider fees on health-care items or15
14311428 services provided by nursing facility providers for the purpose of16
14321429 obtaining federal financial participation under the state's medical17
14331430 assistance program as described in articles 4 to 6 of this title. As specified18
14341431 by the priority of the uses of the provider fee in paragraph (b) of19
14351432 subsection (2) of this section, the provider fees shall be used to sustain or20
14361433 increase reimbursement for providing medical care under the state's21
14371434 medical assistance program for nursing facility providers.22
14381435 (II) For the fiscal years commencing July 1, 2009, and July 1,23
14391436 2010, the provider fee shall not exceed seven dollars and fifty cents per24
14401437 nonmedicare-resident day. For the fiscal year commencing July 1, 2011,25
14411438 and each fiscal year thereafter, the provider fee shall not exceed twelve26
14421439 dollars per nonmedicare-resident day plus inflation based on the national27
14431440 270
14441441 -45- skilled nursing facility market basket index as determined by the secretary1
14451442 of the department of health and human services pursuant to 42 U.S.C. sec.2
14461443 1395yy (e)(5) or any successor index.3
14471444 (III) In calculating the amount of the provider fee portion of the4
14481445 supplemental medicaid payments established under section 25.5-6-2025
14491446 (5), the state department may include an additional amount of up to five6
14501447 percent of the provider fee portion of said supplemental medicaid7
14511448 payments to initiate the payment to any provider who complies with the8
14521449 established performance measures during the state fiscal year.9
14531450 (b) The provider fees shall be charged on a nonmedicare-resident10
14541451 day basis and shall be based upon the aggregate gross or net revenue, as11
14551452 prescribed by the state department, of all nursing facility providers subject12
14561453 to the provider fee. The state department may exempt revenue categories13
14571454 from the gross or net revenue calculation and the collection of the14
14581455 provider fee from nursing facility providers, as authorized by federal law.15
14591456 (c) (I) In accordance with the redistributive method set forth in 4216
14601457 CFR 433.68 (e)(1) and (e)(2), the state department shall seek a waiver17
14611458 from the broad-based provider fees requirement or the uniform provider18
14621459 fees requirement, or both, to exclude nursing facility providers from the19
14631460 provider fee. The state department shall exempt the following nursing20
14641461 facility providers to obtain federal approval and minimize the financial21
14651462 impact on nursing facility providers:22
14661463 (A) A facility operated as a continuing care retirement community23
14671464 that provides a continuum of services by one operational entity providing24
14681465 independent living services, assisted living services, and skilled nursing25
14691466 care on a single, contiguous campus. Assisted living services include an26
14701467 assisted living residence as defined in section 25-27-102 or that provides27
14711468 270
14721469 -46- assisted living services on-site, twenty-four hours per day, seven days per1
14731470 week.2
14741471 (B) A skilled nursing facility owned and operated by the state;3
14751472 (C) A nursing facility that is a distinct part of a facility that is4
14761473 licensed as a general acute care hospital; and5
14771474 (D) A facility that has forty-five or fewer licensed beds.6
14781475 (II) No later than July 1, 2026, the state department shall7
14791476 promulgate rules maintaining the exemptions identified in this subsection8
14801477 (1)(c) in order to minimize the financial impact on nursing facility9
14811478 providers.10
14821479 (III) This subsection (1)(c) is repealed, effective July 1, 2028.11
14831480 (d) The state department may lower the amount of the provider fee12
14841481 charged to certain nursing facility providers to meet the requirements of13
14851482 42 CFR 433.68 (e) and to obtain federal approval.14
14861483 (e) The imposition and collection of a provider fee shall be15
14871484 prohibited without the federal government's approval of a state medicaid16
14881485 plan amendment authorizing federal financial participation for the17
14891486 provider fees. The state department may alter the method prescribed in18
14901487 this section to the extent necessary to meet the federal requirements and19
14911488 to obtain federal approval.20
14921489 (f) If the provider fee required by this subsection (1) is not21
14931490 approved by the federal government, notwithstanding any other provision22
14941491 of this section, the state department shall not implement the assessment23
14951492 or collection of the provider fee from nursing facility providers.24
14961493 (g) The state department shall establish a schedule to assess and25
14971494 collect the provider fee on a monthly basis. The state board shall establish26
14981495 rules so that provider fee payments from a nursing facility provider and27
14991496 270
15001497 -47- the state department's supplemental medicaid payments to the nursing1
15011498 facility are due as nearly simultaneously as feasible; except that the state2
15021499 department's supplemental medicaid payments to the nursing facility shall3
15031500 be due no more than fifteen days after the provider fee payment is4
15041501 received from the nursing facility. The state department shall require each5
15051502 nursing facility provider to report annually its total number of days of care6
15061503 provided to nonmedicare residents.7
15071504 (h) The state department shall not assess or collect the provider8
15081505 fee until state medicaid plan amendments adopting the medicaid9
15091506 reimbursement system for the state's class I nursing facility providers,10
15101507 pursuant to section 25.5-6-202, including the waiver with respect to the11
15111508 provider fees pursuant to this section, have been approved by the federal12
15121509 government.13
15131510 (i) The state board shall promulgate any rules pursuant to the14
15141511 "State Administrative Procedure Act", article 4 of title 24, C.R.S.,15
15151512 necessary for the administration and implementation of this section.16
15161513 (j) A nursing facility provider shall not include any amount of the17
15171514 provider fee as a separate line item in its billing statements.18
15181515 (2) (a.5) N
15191516 OTWITHSTANDING ANY PROVISION OF THIS SUBSECTION19
15201517 (2)
15211518 TO THE CONTRARY, ON JUNE 30, 2025, THE STATE TREASURER SHALL20
15221519 TRANSFER THE BALANCE OF THE FUND TO THE HEALTHCARE21
15231520 AFFORDABILITY AND SUSTAINABILITY NURSING FACILITY PROVIDER FEE22
15241521 CASH FUND CREATED IN SECTION 25.5-4-402.4 (5.5).23
15251522 (3) T
15261523 HIS SECTION IS REPEALED, EFFECTIVE JULY 1, 2025.24
15271524 SECTION 6. In Colorado Revised Statutes, 25.5-6-204, amend25
15281525 (1)(c) as follows:26
15291526 25.5-6-204. Providers - reimbursement - intermediate care27
15301527 270
15311528 -48- facility for individuals with intellectual disabilities - reimbursement1
15321529 - maximum allowable - repeal. (1) (c) (I) Beginning in fiscal year2
15331530 2013-14, and for each fiscal year thereafter, the state department is3
15341531 authorized to charge both privately owned intermediate care facilities for4
15351532 individuals with intellectual disabilities and state-operated intermediate5
15361533 care facilities for individuals with intellectual disabilities a service fee for6
15371534 the purposes of maintaining the quality and continuity of services7
15381535 provided by intermediate care facilities for individuals with intellectual8
15391536 disabilities. The service fee charged by the state department pursuant to9
15401537 this paragraph (c) will be assessed pursuant to rules adopted by the state10
15411538 board but must not exceed five percent of the total costs incurred by all11
15421539 intermediate care facilities for the fiscal year in which the service fee is12
15431540 charged. The state board shall adopt rules consistent with federal law in13
15441541 order to implement the provisions of this paragraph (c).14
15451542 (II) The moneys collected in each fiscal year pursuant to15
15461543 subparagraph (I) of this paragraph (c) shall be transmitted by the state16
15471544 department to the state treasurer, who shall credit the same to The service17
15481545 fee fund which fund is hereby created and referred to in this paragraph (c)18
15491546 SUBSECTION (1)(c) as the "fund". The moneys MONEY in the fund shall be19
15501547 subject to annual appropriation by the general assembly to the state20
15511548 department to be used toward the state match for the federal financial21
15521549 participation to reimburse intermediate care facilities for individuals with22
15531550 intellectual disabilities pursuant to this section. Any unexpended and23
15541551 unencumbered moneys MONEY remaining in the fund at the end of any24
15551552 fiscal year shall remain in the fund and not be credited or transferred to25
15561553 the general fund or any other fund.26
15571554 (III) (A) N
15581555 OTWITHSTANDING ANY PROVISION OF THIS SUBSECTION27
15591556 270
15601557 -49- (1)(c) TO THE CONTRARY, ON JUNE 30, 2025, THE STATE TREASURER SHALL1
15611558 TRANSFER THE BALANCE OF THE SERVICE FEE FUND TO THE HEALTHCARE2
15621559 AFFORDABILITY AND SUSTAINABILITY INTERMEDIATE CARE FACILITY FEE3
15631560 CASH FUND CREATED IN SECTION 25.5-4-402.4 (5.7).4
15641561 (B) T
15651562 HIS SUBSECTION (1)(c) IS REPEALED, EFFECTIVE JULY 1, 2025.5
15661563 SECTION 7. In Colorado Revised Statutes, 25.5-6-210, amend6
15671564 (4)(b) as follows:7
15681565 25.5-6-210. Additional supplemental payments - nursing8
15691566 facilities - funding methodology - reporting requirement - rules -9
15701567 repeal. (4) (b) For the purposes of federal upper payment limit10
15711568 calculations, the state department shall pursue federal matching funds for11
15721569 payments made pursuant to this section but only after securing federal12
15731570 matching funds for payments outlined in sections 25.5-6-203 (2)
15741571 13
15751572 SECTIONS 25.5-4-402.4 (5.5)(b) and 25.5-6-208. 14
15761573 SECTION 8. In Colorado Revised Statutes, 25-3-108, amend (7)15
15771574 as follows:16
15781575 25-3-108. Receivership. (7) The department of public health and17
15791576 environment shall grant the receiver a license pursuant to section18
15801577 25-3-102 and shall recommend certification for medicaid participation,19
15811578 and the department of health care policy and financing
15821579 AND THE20
15831580 C
15841581 OLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY21
15851582 ENTERPRISE shall reimburse the receiver for the long-term health-care22
15861583 facility's medicaid residents pursuant to section
15871584 SECTIONS 25.5-6-20423
15881585 C.R.S. AND 25.5-4-402.4 (5.7).24
15891586 SECTION 9. In Colorado Revised Statutes, amend 2-3-119 as25
15901587 follows:26
15911588 2-3-119. Audit of healthcare affordability and sustainability27
15921589 270
15931590 -50- hospital provider fee - cost shift. At the discretion of the legislative1
15941591 audit committee, the state auditor shall conduct or cause to be conducted2
15951592 a performance and fiscal audit of the healthcare affordability and3
15961593 sustainability
15971594 HOSPITAL PROVIDER fee established pursuant to section4
15981595 25.5-4-402.4.5
15991596 SECTION 10. In Colorado Revised Statutes, 7-121-401, amend6
16001597 (33.5)(b)(V) as follows:7
16011598 7-121-401. General definitions. As used in articles 121 to 137 of8
16021599 this title 7, unless the context otherwise requires:9
16031600 (33.5) (b) Notwithstanding subsection (33.5)(a) of this section,10
16041601 "residential nonprofit corporation" does not include:11
16051602 (V) A continuing care retirement community, as described in12
16061603 section 25.5-6-203, C.R.S.
16071604 SECTION 25.5-4-402.4 (4.5)(d)(II)(A), operated13
16081605 by an entity that is licensed or otherwise subject to state regulation.14
16091606 SECTION 11. In Colorado Revised Statutes, 10-16-1205, amend15
16101607 (5)(a) as follows:16
16111608 10-16-1205. Health insurance affordability fee - special17
16121609 assessment on hospitals - allocation of revenues. (5) (a) The special18
16131610 assessments on hospitals under subsection (1)(a)(II) of this section must19
16141611 comply with and not violate 42 CFR 433.68. If the federal centers for20
16151612 medicare and medicaid services in the United States department of health21
16161613 and human services informs the state that the state will not be in22
16171614 compliance with 42 CFR 433.68 as a result of the special assessment on23
16181615 hospitals pursuant to subsection (1)(a)(II) of this section, the enterprise24
16191616 shall reduce the amount of the special assessment as necessary to avoid25
16201617 any reduction in the healthcare affordability and sustainability
16211618 HOSPITAL26
16221619 PROVIDER fee collected pursuant to section 25.5-4-402.4.27
16231620 270
16241621 -51- SECTION 12. In Colorado Revised Statutes, 25.5-4-402.8,1
16251622 amend (2)(g)(I) as follows:2
16261623 25.5-4-402.8. Hospital transparency report and requirements3
16271624 - definitions. (2) (g) (I) If a hospital does not provide all of the4
16281625 information required pursuant to subsection (2)(b) of this section, the5
16291626 state department shall inform the hospital of its noncompliance within6
16301627 sixty days and identify the information that needs to be provided. If a7
16311628 hospital does not comply, the state department shall issue a corrective8
16321629 action plan with a timeline of sixty days required for compliance. If a9
16331630 hospital continues to not comply, the state department may create a10
16341631 mandatory pay-for-reporting compliance measure within the hospital11
16351632 transformation program that is tied to the healthcare affordability and12
16361633 sustainability
16371634 HOSPITAL PROVIDER fee supplemental payment and is based13
16381635 on compliance with subsection (2)(b) of this section.14
16391636 SECTION 13. In Colorado Revised Statutes, 25.5-5-201, amend15
16401637 (1)(o)(II) and (1)(r)(II) as follows:16
16411638 25.5-5-201. Optional provisions - optional groups - rules.17
16421639 (1) (o) (II) Notwithstanding the provisions of subsection (1)(o)(I) of this18
16431640 section, if the money in the healthcare affordability and sustainability19
16441641 HOSPITAL PROVIDER fee cash fund established pursuant to section20
16451642 25.5-4-402.4, together with the corresponding federal matching funds, is21
16461643 insufficient to fully fund all of the purposes described in section22
16471644 25.5-4-402.4 (5)(b), after receiving recommendations from the Colorado23
16481645 healthcare affordability and sustainability enterprise established pursuant24
16491646 to section 25.5-4-402.4 (3), for individuals with disabilities who are25
16501647 participating in the medicaid buy-in program established in part 14 of26
16511648 article 6 of this title 25.5, the state board by rule adopted pursuant to the27
16521649 270
16531650 -52- provisions of section 25.5-4-402.4 (6)(b)(III) may reduce the medical1
16541651 benefits offered or the percentage of the federal poverty line to below2
16551652 four hundred fifty percent or may eliminate this eligibility group.3
16561653 (r) (II) Notwithstanding the provisions of subsection (1)(r)(I) of4
16571654 this section, if the money in the healthcare affordability and sustainability5
16581655 HOSPITAL PROVIDER fee cash fund established pursuant to section6
16591656 25.5-4-402.4, together with the corresponding federal matching funds, is7
16601657 insufficient to fully fund all of the purposes described in section8
16611658 25.5-4-402.4 (5)(b), after receiving recommendations from the Colorado9
16621659 healthcare affordability and sustainability enterprise established pursuant10
16631660 to section 25.5-4-402.4 (3), for persons eligible for a medicaid buy-in11
16641661 program established pursuant to section 25.5-5-206, the state board by12
16651662 rule adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III)13
16661663 may reduce the medical benefits offered, or the percentage of the federal14
16671664 poverty line, or may eliminate this eligibility group.15
16681665 SECTION 14. In Colorado Revised Statutes, 25.5-5-204.5,16
16691666 amend (2) as follows:17
16701667 25.5-5-204.5. Continuous eligibility - children.18
16711668 (2) Notwithstanding the provisions of subsection (1) of this section, if the19
16721669 money in the healthcare affordability and sustainability
16731670 HOSPITAL20
16741671 PROVIDER fee cash fund established pursuant to section 25.5-4-402.4,21
16751672 together with the corresponding federal matching funds, is insufficient to22
16761673 fully fund all of the purposes described in section 25.5-4-402.4 (5)(b),23
16771674 after receiving recommendations from the Colorado healthcare24
16781675 affordability and sustainability enterprise established pursuant to section25
16791676 25.5-4-402.4 (3), the state board by rule adopted pursuant to the26
16801677 provisions of section 25.5-4-402.4 (6)(b)(III) may eliminate the27
16811678 270
16821679 -53- continuous enrollment requirement pursuant to this section.1
16831680 SECTION 15. In Colorado Revised Statutes, 25.5-6-1403,2
16841681 amend (5)(b) as follows:3
16851682 25.5-6-1403. Waivers and amendments. (5) (b) The state4
16861683 department shall not prepare and submit the amendments to the state5
16871684 medical assistance plan pursuant to this subsection (5) if there are6
16881685 insufficient revenues from the healthcare affordability and sustainability7
16891686 HOSPITAL PROVIDER fee cash fund, created in section 25.5-4-402.4, for the8
16901687 administrative expenses associated with preparing and submitting the9
16911688 state plan amendments. If there are insufficient revenues from the10
16921689 healthcare affordability and sustainability
16931690 HOSPITAL PROVIDER fee cash11
16941691 fund, the state department may accept and expend gifts, grants, or12
16951692 donations for this purpose.13
16961693 SECTION 16. In Colorado Revised Statutes, 25.5-8-103, amend14
16971694 (4)(a)(II) and (4)(b)(II) as follows:15
16981695 25.5-8-103. Definitions - rules. As used in this article 8, unless16
16991696 the context otherwise requires:17
17001697 (4) "Eligible person" means:18
17011698 (a) (II) Notwithstanding the provisions of subsection (4)(a)(I) of19
17021699 this section, if the money in the healthcare affordability and sustainability20
17031700 HOSPITAL PROVIDER fee cash fund established pursuant to section21
17041701 25.5-4-402.4 (5), together with the corresponding federal matching funds,22
17051702 is insufficient to fully fund all of the purposes described in section23
17061703 25.5-4-402.4 (5)(b), after receiving recommendations from the Colorado24
17071704 healthcare affordability and sustainability enterprise established pursuant25
17081705 to section 25.5-4-402.4 (3), for persons less than nineteen years of age,26
17091706 the state board may by rule adopted pursuant to the provisions of section27
17101707 270
17111708 -54- 25.5-4-402.4 (6)(b)(III) reduce the percentage of the federal poverty line1
17121709 to below two hundred sixty percent, but the percentage shall not be2
17131710 reduced to below two hundred thirteen percent.3
17141711 (b) (II) Notwithstanding the provisions of subsection (4)(b)(I) of4
17151712 this section, if the money in the healthcare affordability and sustainability5
17161713 HOSPITAL PROVIDER fee cash fund established pursuant to section6
17171714 25.5-4-402.4 (5), together with the corresponding federal matching funds,7
17181715 is insufficient to fully fund all of the purposes described in section8
17191716 25.5-4-402.4 (5)(b), after receiving recommendations from the Colorado9
17201717 healthcare affordability and sustainability enterprise established pursuant10
17211718 to section 25.5-4-402.4 (3), for pregnant women, the state board by rule11
17221719 adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III) may12
17231720 reduce the percentage of the federal poverty line to below two hundred13
17241721 sixty percent, but the percentage shall not be reduced to below two14
17251722 hundred thirteen percent.15
17261723 SECTION 17. Appropriation - adjustments to 2025 long bill.16
17271724 (1) To implement this act, appropriations made in the annual general17
17281725 appropriation act for the 2025-26 state fiscal year to the department of18
17291726 health care policy and financing from the Medicaid nursing facility cash19
17301727 fund created in section 25.5-6-203 (2)(a), C.R.S., are decreased as20
17311728 follows:21
17321729 Executive director's office, general administration22
17331730 Personal services $246,81123
17341731 Health, life, and dental $30,95324
17351732 Short-term disability $6525
17361733 Paid family and medical leave insurance $1,15326
17371734 Unfunded liability amortization equalization 27
17381735 270
17391736 -55- disbursement payments $15,6051
17401737 Salary survey $6,8992
17411738 Step pay $4613
17421739 PERA direct distribution $5,0264
17431740 Workers' compensation $7885
17441741 Operating expenses $13,2006
17451742 Payment to risk management and property funds $7727
17461743 Leased space $17,1918
17471744 Payments to OIT $59,5139
17481745 CORE operations $12310
17491746 General professional services and special projects $1,25011
17501747 Executive director's office, utilization and quality review 12
17511748 contracts13
17521749 Professional services contracts $36,87514
17531750 Executive director's office, provider audits and services15
17541751 Professional audit contracts $12,42016
17551752 Executive director's office, indirect cost recoveries17
17561753 Indirect cost assessment $12,11618
17571754 Medical services premiums19
17581755 Medical and long-term care services for Medicaid 20
17591756 eligible individuals $62,525,00021
17601757 (2) For the 2025-26 state fiscal year, $62,986,221 is appropriated22
17611758 to the department of health care policy and financing. This appropriation23
17621759 is from the healthcare affordability and sustainability nursing facility24
17631760 provider fee cash fund created in section 25.5-4-402.4 (5.5)(a), C.R.S. To25
17641761 implement this act, the department may use this appropriation as follows:26
17651762 Executive director's office, general administration27
17661763 270
17671764 -56- Personal services $246,8111
17681765 Health, life, and dental $30,9532
17691766 Short-term disability $653
17701767 Paid family and medical leave insurance $1,1534
17711768 Unfunded liability amortization equalization 5
17721769 disbursement payments $15,6056
17731770 Salary survey $6,8997
17741771 Step pay $4618
17751772 PERA direct distribution $5,0269
17761773 Workers' compensation $78810
17771774 Operating expenses $13,20011
17781775 Payment to risk management and property funds $77212
17791776 Leased space $17,19113
17801777 Payments to OIT $59,51314
17811778 CORE operations $12315
17821779 General professional services and special projects $1,25016
17831780 Executive director's office, utilization and quality review 17
17841781 contracts18
17851782 Professional services contracts $36,87519
17861783 Executive director's office, provider audits and services20
17871784 Professional audit contracts $12,42021
17881785 Executive director's office, indirect cost recoveries22
17891786 Indirect cost assessment $12,11623
17901787 Medical services premiums24
17911788 Medical and long-term care services for Medicaid 25
17921789 eligible individuals $62,525,00026
17931790 (3) To implement this act, appropriations made in the annual general27
17941791 270
17951792 -57- appropriation act for the 2025-26 state fiscal year to the department of1
17961793 health care policy and financing from the service fee fund created in2
17971794 section 25.5-6-204 (1)(c)(II), C.R.S., are decreased as follows:3
17981795 Executive director's office, general administration4
17991796 Personal services $36,4765
18001797 Health, life, and dental $4,9556
18011798 Short-term disability $157
18021799 Paid family and medical leave insurance $1698
18031800 Unfunded liability amortization equalization 9
18041801 disbursement payments $2,28710
18051802 Salary survey $1,15011
18061803 Step pay $6712
18071804 PERA direct distribution $73713
18081805 Workers' compensation $11614
18091806 Operating expenses $1,87615
18101807 Payment to risk management and property funds $11416
18111808 Leased space $2,37117
18121809 Payments to OIT $8,78918
18131810 CORE operations $1819
18141811 Executive director's office, indirect cost recoveries20
18151812 Indirect cost assessment $1,77821
18161813 Medical services premiums22
18171814 Medical and long-term care services for Medicaid 23
18181815 eligible individuals $200,46024
18191816 Transfers to other state department Medicaid-funded programs, 25
18201817 human services26
18211818 Regional centers for people with developmental 27
18221819 270
18231820 -58- disabilities $1,888,9031
18241821 (4) For the 2025-26 state fiscal year, $2,150,281 is appropriated to the2
18251822 department of health care policy and financing. This appropriation is from3
18261823 the healthcare affordability and sustainability intermediate care facility4
18271824 fee cash fund created in section 25.5-4-402.4 (5.7)(a), C.R.S. To5
18281825 implement this act, the department may use this appropriation as follows:6
18291826 Executive director's office, general administration7
18301827 Personal services $36,4768
18311828 Health, life, and dental $4,9559
18321829 Short-term disability $1510
18331830 Paid family and medical leave insurance $16911
18341831 Unfunded liability amortization equalization 12
18351832 disbursement payments $2,28713
18361833 Salary survey $1,15014
18371834 Step pay $6715
18381835 PERA direct distribution $73716
18391836 Workers' compensation $11617
18401837 Operating expenses $1,87618
18411838 Payment to risk management and property funds $11419
18421839 Leased space $2,37120
18431840 Payments to OIT $8,78921
18441841 CORE operations $1822
18451842 Executive director's office, indirect cost recoveries23
18461843 Indirect cost assessment $1,77824
18471844 Medical services premiums25
18481845 Medical and long-term care services for Medicaid 26
18491846 eligible individuals $200,46027
18501847 270
18511848 -59- Transfers to other state department Medicaid-funded programs, 1
18521849 human services2
18531850 Regional centers for people with developmental 3
18541851 disabilities $1,888,9034
18551852 270
18561853 -60- APPROPRIATION FROM
18571854 ITEM &
18581855 SUBTOTAL
18591856 TOTAL GENERAL
18601857 FUND
18611858 GENERAL
18621859 FUND
18631860 EXEMPT
18641861 CASH
18651862 FUNDS
18661863 REAPPROPRIATED
18671864 FUNDS
18681865 FEDERAL
18691866 FUNDS
18701867 $$$$$ $ $
18711868 SECTION 18. Appropriation to the department of health care policy and financing for the fiscal year beginning July 1, 2024. In Session Laws of Colorado 2024, section
18721869 1
18731870 2 of chapter 519, (HB 24-1430), amend Part VI (2) and (7)(C)(6), as Part VI (2) and the affected totals are amended by section 1 of SB 25-093, as follows:
18741871 2
18751872 Section 2. Appropriation.
18761873 3
18771874 PART VI
18781875 4
18791876 DEPARTMENT OF HEALTH CARE POLICY AND FINANCING
18801877 5
18811878 6
18821879 (2) MEDICAL SERVICES PREMIUMS
18831880 7
18841881 Medical and Long-Term
18851882 8
18861883 Care Services for Medicaid
18871884 9
18881885 Eligible Individuals
18891886 24a
18901887 10 12,081,998,495
18911888 2,376,915,878
18921889 (M)
18931890 1,247,280,333
18941891 a
18951892 1,399,855,214
18961893 b
18971894 119,588,730
18981895 c
18991896 6,938,358,340
19001897 11
19011898 a
19021899 This amount shall be from the General Fund Exempt Account created in Section 24-77-103.6 (2), C.R.S.
19031900 12
19041901 270
19051902 -61- APPROPRIATION FROM
19061903 ITEM &
19071904 SUBTOTAL
19081905 TOTAL GENERAL
19091906 FUND
19101907 GENERAL
19111908 FUND
19121909 EXEMPT
19131910 CASH
19141911 FUNDS
19151912 REAPPROPRIATED
19161913 FUNDS
19171914 FEDERAL
19181915 FUNDS
19191916 $$$$$ $ $
19201917 b
19211918 Of this amount, $1,062,923,207 shall be from the Healthcare Affo rdability and Sustainability Fee Ca sh Fund created in Section 25.5-4-402.4 (5)(a), C.R.S., $76,010,738 shall be from
19221919 1
19231920 recoveries and recoupments, $58,197,249
19241921 $48,415,351 shall be from the Medicaid Nursing Facility Cash Fund created in Section 25.5- 6-203 (2)(a), C.R.S., $54,010,364 re presents public
19251922 2
19261923 funds certified as expenditures incurred by public emergency medical transportation providers, $52,400,466 shall be from the Ad ult Dental Fund created in Section 25.5-5-207 (4)(a),
19271924 3
19281925 C.R.S., $46,929,200 shall be from the Health Care Expansion Fund created in Section 24-22-117 (2)(a)(I), C.R.S., $24,736,077 re presents public funds certified as expenditures incurred
19291926 4
19301927 by public hospitals and agencies that are eligible for federal financial participation under the Medicaid program, $20,376,822 shall be from the Home- and Community-based Services
19311928 5
19321929 Improvement Fund created in Section 25.5-6-1805 (1), C.R.S., $9,781,898
19331930 SHALL BE FROM THE
19341931 H
19351932 EALTHCARE
19361933 A
19371934 FFORDABILITY AND
19381935 S
19391936 USTAINABILITY NURSING FACILITY PROVIDER FEE
19401937 6
19411938 CASH FUND CREATED IN
19421939 S
19431940 ECTION
19441941 25.5-4-402.4 (5.5)(a), C.R.S., $1,491,000 shall be from the Tobacco Tax Cash Fund created in section 24-22-117 (1)(a), C.R.S., and meets the
19451942 7
19461943 requirement to appropriate a portion of the revenues collected from the imposition of additional state cigarette and tob acco taxes to the Old Age Pension program for health related
19471944 8
19481945 purposes pursuant to Section 21 of Article X of the State Co nstitution, $857,151 shall be from the Tobacco Education Programs F und created in Section 24-22-117 (2)(c)(I), C.R.S.,
19491946 9
19501947 $700,000 shall be from an intergovernmental transfer from Denver Health, $ 550,798 shall be from the Breast and Cervical Cancer Prevention and Treatment Fund created in Section
19511948 10
19521949 25.5-5-308 (8)(a)(I), C.R.S., $471,682 shall be from the ARPA Home- and Community-Based Services Account created in Section 25. 5-4-402.4 (5)(c)(I)(A), C.R.S., and $200,460 shall
19531950 11
19541951 be from the Service Fee Fund created in Section 25.5-6-204 (1)(c)(II), C.R.S.
19551952 12
19561953 c
19571954 Of this amount, $107,671,715 shall be transferred from the Department of Higher Education from the Fee-for-service Contracts w ith State Institutions for Speciality Education
19581955 13
19591956 Programs line item, $9,253,841 shall be transferred from the Old Age Pension State Medical Program line item appropriation in t he Other Medical Services division of this
19601957 14
19611958 department, $1,505,000 shall be from the De partment of Early Childhood from the Home Visiting line item, and $1,158,174 shall b e transferred from Public School Health Services
19621959 15
19631960 line item in the Other Medical Services division of this department.
19641961 16
19651962 270
19661963 -62- APPROPRIATION FROM
19671964 ITEM &
19681965 SUBTOTAL
19691966 TOTAL GENERAL
19701967 FUND
19711968 GENERAL
19721969 FUND
19731970 EXEMPT
19741971 CASH
19751972 FUNDS
19761973 REAPPROPRIATED
19771974 FUNDS
19781975 FEDERAL
19791976 FUNDS
19801977 $$$$$ $ $
19811978 1
19821979 (7) TRANSFERS TO OTHER STATE DEPARTMENT MEDICAID-FUNDED PROGRAMS
19831980 2
19841981 (C) Human Services
19851982 3
19861983 (6) Office of Adults, Aging and Disability Services
19871984 4
19881985 Administration
19891986 5 505,357
19901987 252,679
19911988 (M)
19921989 252,678
19931990 Regional Centers for People
19941991 6
19951992 with Developmental
19961993 7
19971994 Disabilities
19981995 8 58,276,921
19991996 27,249,558
20001997 (M)
20011998 1,888,903
20021999 a
20032000 29,138,460
20042001 Community Services for the
20052002 9
20062003 Elderly
20072004 10 1,001,800
20082005 500,900
20092006 (M)
20102007 500,900
20112008 11 59,784,078 12
20122009 a
20132010 This
20142011 O
20152012 F THIS
20162013 amount $1,530,432 shall be from the Service Fee Fund created in Section 25.5-6-204 (1)(c)(II), C.R.S.,
20172014 AND
20182015 $358,471
20192016 SHALL BE FROM THE
20202017 H
20212018 EALTHCARE
20222019 13
20232020 A
20242021 FFORDABILITY AND
20252022 S
20262023 USTAINABILITY
20272024 I
20282025 NTERMEDIATE
20292026 C
20302027 ARE
20312028 F
20322029 ACILITY
20332030 C
20342031 ASH
20352032 F
20362033 UND CREATED IN
20372034 S
20382035 ECTION
20392036 25.5-4-402.4 (5.7)(a), C.R.S.
20402037 14
20412038 15
20422039 270
20432040 -63- APPROPRIATION FROM
20442041 ITEM &
20452042 SUBTOTAL
20462043 TOTAL GENERAL
20472044 FUND
20482045 GENERAL
20492046 FUND
20502047 EXEMPT
20512048 CASH
20522049 FUNDS
20532050 REAPPROPRIATED
20542051 FUNDS
20552052 FEDERAL
20562053 FUNDS
20572054 $$$$$ $ $
20582055 1
20592056 TOTALS PART VI
20602057 2
20612058 (HEALTH CARE
20622059 3
20632060 POLICY AND
20642061 4
20652062 FINANCING)
20662063 30
20672064 5 $16,304,072,844
20682065 $3,819,066,512
20692066 $1,247,571,367
20702067 a
20712068 $1,913,251,446
20722069 b
20732070 $137,592,164
20742071 $9,186,591,355
20752072 c
20762073 6
20772074 a
20782075 Of this amount, $1,247,280,333 shall be from the General Fund Exempt Account created in Section 24-77-103.6 (2), C.R.S., and $ 291,034 shall be General Fund Exempt pursuant
20792076 7
20802077 to Section 24-22-117 (1)(c)(I)(B.5), C.R.S. Said $291,034 is not subject to the statutory limitation on General Fund appropriat ions imposed by Section 24-75-201.1, C.R.S.
20812078 8
20822079 b
20832080 Of this amount, $19,254,185 contains an (I) notation.
20842081 9
20852082 c
20862083 Of this amount, $438,736,989 contains an (I) notation.
20872084 10
20882085 11
20892086 270
20902087 -64- SECTION 19. Effective date. This act takes effect May 1, 2025.1
20912088 SECTION 20. Safety clause. The general assembly finds,2
20922089 determines, and declares that this act is necessary for the immediate3
20932090 preservation of the public peace, health, or safety or for appropriations for4
20942091 the support and maintenance of the departments of the state and state5
20952092 institutions.6
20962093 270
20972094 -65-