First Regular Session Sixty-seventh General Assembly STATE OF COLORADO INTRODUCED LLS NO. 09-0145.01 Brita Darling HOUSE BILL 09-1028 HOUSE SPONSORSHIP Frangas, SENATE SPONSORSHIP (None), House Committees Senate Committees Health and Human Services . A BILL FOR AN ACT Concerning the creation of an accountability board to review grievances related to the Colorado indigent care program. Bill Summary (Note: This summary applies to this bill as introduced and does not necessarily reflect any amendments that may be subsequently adopted.) Health Care Task Force. Creates an accountability board (board) in the department of health care policy and financing (state department) to review grievances concerning the administration of the Colorado indigent care program (program) and the medical services provided under the program. Requires the medical services board to adopt rules for the administration of the board and the process by which the board will review selected grievances. Requires the rules to include possible remedies that the board may recommend to the state department for resolution of a grievance. Requires the board to refer any report of malfeasance or of the misuse or abuse of funds to the executive director of the state department, who shall notify the appropriate supervisory or regulatory authority. Requires the executive director of the state department to appoint members to the board. Provides that members of the board shall serve without compensation. Allows the board to review grievances relating to the need for, type, or quality of medical services provided to medically indigent persons under the program. Requires the board to report quarterly, in writing, concerning the nature of grievances reviewed and the recommendation of the board. Repeals the statute creating the board. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Part 1 of article 3 of title 25.5, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read: 25.5-3-108.5. Colorado indigent care program accountability board - legislative declaration - creation - rules - duties - repeal. (1) The general assembly hereby finds and declares that Colorado has limited economic resources available to meet the significant need for medical services that exists in our communities. Accordingly, Colorado has an obligation to monitor state-funded health care programs to ensure that quality care is being provided and resources are not lost to waste, fraud, neglect, indifference, or abuse. By creating an accountability board as part of the Colorado indigent care program, the state may better monitor the intended care that providers have a duty to provide under the program and that has been paid for with taxpayers' money. Moreover, medically indigent persons receiving care under the program should have a voice in helping to ensure that the program is providing the type of medical care and the quality of medical care that the program is intended to provide. (2) There is hereby created in the state department the Colorado indigent care program accountability board, referred to in this section as the "board", to review selected grievances submitted by medically indigent persons who have received or are receiving medical services pursuant to this part 1. (3) (a) The medical services board shall adopt rules for the creation and administration of the board and the process for reviewing grievances. The rules shall include, but need not be limited to: (I) The requirement that the board refer any report of malfeasance or of the misuse or abuse of funds to the executive director, who shall notify the appropriate supervisory or regulatory authority of the report; (II) The method for submitting grievances; (III) The criteria for selecting grievances for review by the board, including graduated levels of review, if necessary; (IV) The process for ensuring that the board is presented with all of the facts related to a grievance and that all interested parties have the opportunity to be heard concerning the grievance; and (V) The remedies that the board may recommend to the state department if the board finds that a grievance has merit or that resolution of the grievance is warranted. The remedies may include, but are not limited to: (A) A mandatory second opinion of a diagnosis by a different medical services provider; (B) The transfer of the medically indigent person into the care of a different medical services provider; (C) The treatment of the medically indigent person by a private medical services provider; or (D) The requirement that the medical services provider attend mediation with the medically indigent person or his or her representative. (b) A recommendation by the board concerning a possible remedy or resolution of a grievance shall be transmitted to the state department within ten business days following the board meeting at which the recommendation is made. (4) If the state department does not follow the recommendations of the board regarding appropriate remedies for resolving the grievance, the state department shall notify the medical services board, the board, and the person filing the grievance, in writing, of the state department's reasons for not following the board's recommendations. (5) (a) On or before October 1, 2009, the executive director shall appoint the members of the board, which shall include but need not be limited to an advocate for the medically indigent, a provider of medical services for the medically indigent pursuant to this part 1 who has expertise in community standards of care, and two medically indigent persons who, at the time of their appointment to the board, have received medical services pursuant to this part 1 within the past twenty-four months. (b) Members of the board shall serve two-year terms; except that, of the members initially appointed, half shall serve one-year terms. (c) Members of the board shall not receive compensation but may receive reimbursement for actual and necessary expenses incurred in the conduct of the official business of the board. (d) The executive director shall convene the first meeting of the board. At its first meeting and annually thereafter, the board shall select from among its members persons to serve as president, vice-president, and any other necessary board officers. Thereafter, the board shall meet as necessary upon the call of the president to review selected grievances but shall meet not less than once every three months. (6) The state department shall provide administrative support to the board. (7) The grievances reviewed by the board shall relate to the need for, type, or quality of the medical services provided to a medically indigent person. (8) The board shall have no authority over the state department's administration of medical services pursuant to this part 1 or the reimbursement of medical services pursuant to this part 1 but may make recommendations to the state department concerning these issues. (9) The board shall file a summary report with the state department on a quarterly basis concerning the nature of the grievances reviewed by the board and the board's recommendations concerning the grievances. (10) This section is repealed, effective July 1, 2016. Prior to the repeal, the board shall be reviewed as provided in section 2-3-1203 (3), C.R.S. SECTION 2. 2-3-1203 (3) (cc), Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SUBPARAGRAPH to read: 2-3-1203. Sunset review of advisory committees. (3) The following dates are the dates for which the statutory authorization for the designated advisory committees is scheduled for repeal: (cc) July 1, 2016: (III) The Colorado indigent care program accountability board created in section 25.5-3-108.5, C.R.S.; SECTION 3. Act subject to petition - effective date. This act shall take effect at 12:01 a.m. on the day following the expiration of the ninety-day period after final adjournment of the general assembly that is allowed for submitting a referendum petition pursuant to article V, section 1 (3) of the state constitution, (August 4, 2009, if adjournment sine die is on May 6, 2009); except that, if a referendum petition is filed against this act or an item, section, or part of this act within such period, then the act, item, section, or part, if approved by the people, shall take effect on the date of the official declaration of the vote thereon by proclamation of the governor.