Second Regular Session Sixty-eighth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 12-0246.01 Debbie Haskins x2045 SENATE BILL 12-018 SENATE SPONSORSHIP Lundberg, Harvey, Neville HOUSE SPONSORSHIP (None), Senate Committees House Committees Health and Human Services A BILL FOR AN ACT Concerning the development of an alternative medical assistance program for the elderly. Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://www.leg.state.co.us/billsummaries.) The bill creates a voluntary alternative medical assistance program (program) for the medicaid-eligible elderly. An eligible participant agrees to receive an amount equal to 70% of the medical assistance benefits that he or she would have received if the participant were enrolled in the state's traditional medicaid program in exchange for 2 features currently not allowed under the traditional medicaid program: The participant can choose any provider; and The state waives the right to pursue all estate recovery methods from the participant's family after the participant dies. The participant's physician assesses the level of care the participant needs. The department of health care policy and financing (department) then determines the expected costs to provide that level of care if the participant were enrolled in and were receiving services under the traditional medicaid program and allocates 70% of that amount annually to reimburse providers for the participant's care. The department issues a debit card to the participant that is funded monthly with one-twelfth of the annual amount so allocated to the participant, which the participant uses to pay for medical services while enrolled in the alternative program. The eligible participant purchases long-term care services, assisted living services, home- and community-based services, home health services, prescribed drugs, or any health or dental care service at rates set by the provider, and the participant agrees to provide all additional resources needed for his or her care beyond the 70% medicaid benefit amount provided through the program. The participant is responsible for researching and selecting the services. Each year, the department conducts a redetermination of the participant's eligibility for services and the participant's physician reassesses the level of care that the participant needs. The department must seek a federal waiver for the program. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. In Colorado Revised Statutes, add part 15 to article 6 of title 25.5 as follows: PART 15 ALTERNATIVE MEDICAL ASSISTANCE PROGRAM FOR THE ELDERLY 25.5-6-1501. Definitions. As used in this part 15, unless the context otherwise requires: (1) "Alternative program" means the alternative medical assistance program for the elderly created in this part 15. (2) "Participant" means a person who: (a) Is eligible for the medical assistance program established in this article and articles 4 and 5 of this title; (b) Is fifty-five years of age or older; and (c) Applies to participate in and enrolls in the alternative program. (3) "Service" means a mandated service specified in section 25.5-5-102, an optional service specified in section 25.5-5-202, a long-term care service specified in this article, an assisted living service specified in this article, a home- and community-based service specified in this article, or any other medical or dental care service. "Service" also includes home health services, as defined in section 25.5-4-103 (7), and prescribed drugs. (4) "Traditional medicaid program" means the state's medical assistance program established in this article and articles 4 and 5 of this title. 25.5-6-1502. Alternative medical assistance program - federal authorization - cost recovery - benefits - rules. (1) Subject to obtaining a federal waiver , the state department shall develop and implement an alternative medical assistance program for the elderly. (2) A participant in the alternative program shall: (a) Voluntarily apply to participate in the alternative program, elects to enroll in the alternative program in lieu of enrolling in the traditional medicaid program, and may elect to withdraw from the alternative program after giving thirty days' written notice to the state department; (b) Agree to accept a total annual benefit that is limited to seventy percent of the amount of the annual medicaid benefits the participant could receive under the traditional medicaid program and agree to provide all additional resources needed for his or her care beyond the medicaid benefits provided through the alternative program, in exchange for flexibility in choosing medical care providers and in exchange for the state agreeing not to pursue estate recovery for medical assistance paid to or on behalf of the participant so long as the participant is eligible for the full period that benefits are paid; and (c) Use the moneys provided pursuant to paragraph (b) of this subsection (2) to purchase services from a person or provider, regardless of whether the provider is an approved provider under the traditional medicaid program. The participant bears the responsibility for researching and selecting those services. The participant's physician annually determines the level of care the participant needs. (3) The state department shall: (a) Determine the expected costs to provide the level of care the physician determines the participant would need if the participant were enrolled in and were receiving services under the traditional medicaid program; (b) Allocate to the participant an amount equal to seventy percent of the costs of providing the medical assistance benefits that the participant would have received if he or she had been enrolled in the traditional medicaid program and issue a debit card to the participant, funded monthly with one-twelfth of the annual amount allocated for the participant, which the participant uses to pay for services while enrolled in the alternative program; and (c) Waive the state's right to all estate recovery for medical assistance paid to or on behalf of the participant while the participant is participating in the alternative program, so long as the participant is eligible for the full period that benefits are paid. (4) The state department shall annually redetermine the participant's eligibility for services and consider the annual determination by the participant's physician of the level of care that the participant needs. If the participant's health condition substantially changes, the state department may conduct the annual redetermination before the regularly scheduled date. The state department shall provide case management services only to determine and redetermine eligibility and to assess and reassess the level of care that a participant needs. (5) Any provider in the state may provide a particular service to a participant at a rate to be determined by the provider. (6) The state department shall apply to the applicable federal agency for authorization to operate the alternative program as described in this section. Upon the state department's receipt of the necessary federal authorization, the state board shall adopt and revise rules necessary to implement the alternative program. 25.5-6-1503. Conditional repeal of part - repeal. (1) This part 15 is repealed, effective July 1, 2016, if: (a) The federal government denies the state department's request for authorization to implement the alternative program; and (b) The executive director files written notice with the revisor of statutes stating that the federal government denied the state's request for a waiver. (2) (a) This section is repealed, effective July 1, 2016, if the federal government approves the state department's request for authorization to implement the alternative program. (b) The executive director shall file written notice with the revisor of statutes stating that the federal government approved the state's request for a waiver prior to July 1, 2016, if approval is granted. SECTION 2. In Colorado Revised Statutes, 25.5-4-301, amend (1) (a) (I) as follows: 25.5-4-301. Recoveries - overpayments - penalties - interest - adjustments - liens - review or audit procedures - repeal. (1) (a) (I) Except as provided in section sections 25.5-4-302 and 25.5-6-1502 and subparagraph (III) of this paragraph (a), no recipient or estate of the recipient shall be liable for the cost or the cost remaining after payment by medicaid, medicare, or a private insurer of medical benefits authorized by Title XIX of the social security act, by this title, or by rules promulgated by the state board, which benefits are rendered to the recipient by a provider of medical services authorized to render such service in the state of Colorado, except those contributions required pursuant to section 25.5-4-209 (1). However, a recipient may enter into a documented agreement with a provider under which the recipient agrees to pay for items or services that are nonreimbursable under the medical assistance program. Under these circumstances, a recipient is liable for the cost of such services and items. SECTION 3. Act subject to petition - effective date. This act takes effect at 12:01 a.m. on the day following the expiration of the ninety-day period after final adjournment of the general assembly (August 7, 2012, if adjournment sine die is on May 9, 2012); except that, if a referendum petition is filed pursuant to section 1 (3) of article V of the state constitution against this act or an item, section, or part of this act within such period, then the act, item, section, or part will not take effect unless approved by the people at the general election to be held in November 2012 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.