NOTE: The governor signed this measure on 2/27/2014. HOUSE BILL 14-1252 BY REPRESENTATIVE(S) May and Gerou, Duran, Exum, Fields, Ginal, Hamner, Kraft-Tharp, Labuda, Lee, Mitsch Bush, Peniston, Pettersen, Primavera, Rosenthal, Salazar, Schafer, Singer, Vigil, Williams, Young, Ferrandino; also SENATOR(S) Hodge, Steadman, Lambert, Aguilar, Crowder, Heath, Jones, Kefalas, Kerr, Newell, Nicholson, Schwartz, Todd, Zenzinger, Carroll. Concerning funding for system capacity changes related to intellectual and developmental disabilities waiver services, and, in connection therewith, making and reducing appropriations. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. In Colorado Revised Statutes, 25.5-10-207, amend (1.5), (2), and (3); and add (3.5) as follows: 25.5-10-207. Services and supports - waiting list reduction - cash fund - repeal. (1.5) The state treasurer shall transfer to the intellectual and developmental disabilities services cash fund any available moneys that are appropriated by the general assembly for a fiscal year for adult comprehensive services, adult supported living services, children's extensive support services, and family support services for persons with intellectual and developmental disabilities provided pursuant to this article or part 4 of article 6 of this title that are unexpended and unencumbered at the end of a fiscal year. (2) During each regular session of the general assembly, the joint budget committee and the health and human services committees of the senate and the house of representatives, or any successor committees, shall hold a joint hearing and take public testimony on the status of the waiting lists for adult comprehensive services, adult supported living services, children's extensive support services, and family support services for persons with intellectual and developmental disabilities and the availability of general fund moneys to reduce the number of persons on the waiting lists and the amount of time eligible persons wait for such services. Additionally, the state department, community-centered boards, and providers shall report on the use and effectiveness of any moneys appropriated in the preceding state fiscal year for increasing system capacity. The goal of the hearing shall be to propose an appropriation from the general fund to the intellectual and developmental disabilities services cash fund. (3) The general assembly may annually appropriate moneys in the intellectual and developmental disabilities services cash fund to the state department for: (a) Program costs for adult comprehensive services, adult supported living services, children's extensive support services, and family support services for persons with intellectual and developmental disabilities provided pursuant to this article or part 4 of article 6 of this title; (b) Administrative expenses for renewal and redesign of medicaid home- and community-based services waivers relating to intellectual and developmental disabilities; and (c) Increasing system capacity for home- and community-based intellectual and developmental disabilities programs, services, and supports. (3.5) (a) On or before April 1, 2014, the state department shall report to the joint budget committee concerning the state department's plan for distribution of moneys appropriated for increases in system capacity. The state department shall work with community-centered boards and providers to develop recommendations to the executive director concerning the plan. (b) By April 15, 2014, the state department shall distribute the funds appropriated for increases in system capacity pursuant to the plan described in paragraph (a) of this subsection (3.5). (c) On or before October 1, 2014, each community-centered board or provider that receives moneys for increases in system capacity shall report to the state department concerning the use and effectiveness of those moneys. (d) This subsection (3.5) is repealed, effective July 1, 2015. SECTION 2. Appropriation to the department of health care policy and financing for the fiscal year beginning July 1, 2013. In Session Laws of Colorado 2013, section 2 of chapter 441, (SB 13-230), amend Part V (2), (3), (6) (G), and the affected totals as Part V (6) (G) and the affected totals are amended by section 27 of chapter 169, (HB 13-1117), as follows: Section 2. Appropriation. PART V DEPARTMENT OF HEALTH CARE POLICY AND FINANCING (2) MEDICAL SERVICES PREMIUMS8, 9, 10, 10a Medical and Long-Term Care Services for Medicaid Eligible Individuals 4,438,829,600 1,044,644,433 (M) 469,842,084 a 719,515,157 b 936,892 c 2,203,891,034 4,438,813,623 1,044,636,445 (M) 2,203,883,045 a This amount shall be from the General Fund Exempt Account created in Section 24-77-103.6 (2), C.R.S. b Of this amount, $509,300,034 shall be from the Hospital Provider Fee Cash Fund created in Section 25.5-4-402.3 (4), C.R.S., $67,570,978 shall be from the Health Care Expansion Fund created in Section 24-22-117 (2) (a) (I), C.R.S., $43,137,076 shall be from the Medicaid Nursing Facility Cash Fund created in Section 25.5-6-203 (2) (a), C.R.S., $39,171,453 shall be from recoveries and recoupments, $35,000,000 shall be from an intergovernmental transfer from Denver Health, $19,204,600 represents public funds certified as expenditures incurred by public hospitals and agencies that are eligible for federal financial participation under the Medicaid program, $2,230,500 shall be from the Tobacco Tax Fund created in section 24-22-117 (1) (a), C.R.S. and meets the requirement to appropriate a portion of the revenues collected from the imposition of additional state cigarette and tobacco taxes to the Old Age Pension program for health related purposes pursuant to Section 21 of Article X of the State Constitution, $1,495,066 shall be from the Breast and Cervical Cancer Prevention and Treatment Fund created in Section 25.5-5-308 (8) (a) (I), C.R.S., $1,138,890 shall be from the Medicaid Buy-In Cash Fund created in Section 25.5-6-1404 (3) (b), C.R.S., $640,520 shall be from the Tobacco Education Programs Fund created in Section 24-22-117 (2) (c) (I), C.R.S., $547,520 shall be from the Colorado Autism Treatment Fund created in Section 25.5-6-805 (1), C.R.S., $50,000 shall be from the Coordinated Care for People with Disabilities Fund created in Section 25.5-6-111 (4), C.R.S., and $28,520 shall be from local funds. c This amount shall be transferred from the Department of Public Health and Environment pursuant to Section 24-22-117 (2) (d) (II) (D), C.R.S. (3) BEHAVIORAL HEALTH COMMUNITY PROGRAMS Behavioral Health Capitation Payments 347,419,591 150,983,681 (M) 21,294,827 a 175,141,083 347,448,937 150,998,354 (M) 175,155,756 Medicaid Mental Health Fee for Service Payments 4,801,046 2,400,523 (M) 2,400,523 352,220,637 352,249,983 a Of this amount, $21,260,473 (H) shall be from the Hospital Provider Fee Cash Fund created in Section 25.5-4-402.3 (4), C.R.S., and $34,354 shall be from the Breast and Cervical Cancer Prevention and Treatment Fund created in Section 25.5-5-308 (8) (a) (I), C.R.S. (6) DEPARTMENT OF HUMAN SERVICES MEDICAID-FUNDED PROGRAMS (G) Services for People with Disabilities - Medicaid Funding Community Services for People with Developmental Disabilities, Administration 2,897,037 1,448,519 (M) 1,448,518 Community Services for People with Developmental Disabilities, Program Costs 374,575,651 187,287,826 (M) 1 a 187,287,824 351,011,071 175,505,537 (M) 175,505,533 Regional Centers 45,632,428 22,816,214 (M) 22,816,214 Regional Center Depreciation and Annual Adjustments 1,187,825 593,913 (M) 593,912 424,292,941 400,728,361 a This amount shall be from the Health Care Expansion Fund created in Section 24-22-117 (2) (a) (I), C.R.S. TOTALS PART V (HEALTH CARE POLICY AND FINANCING) $6,195,287,695 $1,601,027,096 $470,280,384 a $1,029,835,723 b $8,483,522 $3,085,660,970 c $6,171,736,484 $1,589,251,492 $3,073,885,363 c a Of this amount, $469,842,084 shall be from the General Fund Exempt Account created in Section 24-77-103.6 (2), C.R.S., and $438,300 shall be General Fund Exempt pursuant to Section 24-22-117 (1) (c) (I) (B), C.R.S. Further, said $438,300 is also not subject to the statutory limitation on General Fund appropriations imposed by Section 24-75-201.1, C.R.S. b Of this amount $10,000,000 contains an (I) notation. c Of this amount $236,968,775 contains an (I) notation. SECTION 3. Appropriation to the department of human services for the fiscal year beginning July 1, 2013. In Session Laws of Colorado 2013, section 2 of chapter 441, (SB 13-230), amend Part VII (9) (A) and the affected totals as amended by section 28 of chapter 169, (HB 13-1117); and add footnote 30a, as follows: Section 2. Appropriation. PART VII DEPARTMENT OF HUMAN SERVICES (9) SERVICES FOR PEOPLE WITH DISABILITIES (A) Community Services for People with Developmental Disabilities (1) Administration Personal Services 2,821,868 226,958 2,594,910 a (34.0 FTE) Operating Expenses 148,523 148,523 a Community and Contract Management System 137,480 41,244 96,236 a Support Level Administration 57,368 57,368 a 3,165,239 a These amounts shall be from Medicaid cash funds transferred from the Community Services for People with Developmental Disabilities, Administration line item in the Department of Health Care Policy and Financing. (2) Program Costs30 Costs30,30a Adult Comprehensive Services for 4,471.2 Medicaid Full Program Equivalents (FPE) 329,907,455 308,770,967 Adult Supported Living Services for 692 General Fund FPE and 3,417.5 Medicaid FPE 46,728,721 47,881,017 Family Support Services 3,255,842 Children's Extensive Support Services for 659 Medicaid FPE 13,201,051 12,424,408 Case Management for 692 General Fund and 8,547.7 Medicaid FPE 25,717,760 22,914,015 Eligibility Determination and Waiting List Management 2,987,431 Preventive Dental Hygiene31 64,239 421,862,499 16,484,491 30,802,357 a 374,575,651 b 398,297,919 351,011,071 b a Of this amount, $30,798,715 shall be from client cash sources, and $3,642 shall be from local funds. The (L) and (I) notation shall apply to $3,642. b This amount shall be from Medicaid funds transferred from the Community Services for People with Developmental Disabilities, Program Costs line item in the Department of Health Care Policy and Financing. TOTALS PART VII (HUMAN SERVICES) $2,183,134,409 $698,239,511 $356,215,550 a $517,852,655 b $610,826,693 c $2,159,569,829 $494,288,075 b a Of this amount, $126,014,974 contains an (L) notation and $226,061,001 contains an (I) notation. b Of this amount, $1,330,200 contains an (I) notation. c Of this amount, $274,250,552 contains an (I) notation. FOOTNOTES -- The following statements are referenced to the numbered footnotes throughout section 2. 20 Department of Human Services, County Administration, County Administration; and Adult Assistance Programs, Adult Protective Services, Adult Protective Services -- It is the intent of the General Assembly that any amount in the Adult Protective Services line item that is not required for the provision of adult protective services may be transferred to the County Administration line item and used to provide additional benefits under that program. It is further the intent of the General Assembly that if county spending exceeds the total appropriations from the Adult Protective Services line item, any amount in the County Administration line item that is not required for the provision of services under that program may be transferred to the Adult Protective Services line item and used to provide adult protective services. 21 Department of Human Services, County Administration, County Share of Offsetting Revenues -- It is the intent of the General Assembly that, pursuant to Section 26-13-108, C.R.S., the Department utilize recoveries to offset the costs of providing public assistance. This appropriation represents an estimate of the county share of such recoveries and, if the amount of the county share of such recoveries is greater than the amount reflected in this appropriation, the Department is authorized to disburse an amount in excess of this appropriation to reflect the actual county share of such recoveries. 22 Department of Human Services, County Administration, County Incentive Payments; Office of Self Sufficiency, Colorado Works Program, County Block Grants; Child Support Enforcement, Child Support Enforcement -- It is the intent of the General Assembly that, pursuant to Sections 26-13-108 and 26-13-112.5 (2), C.R.S., the Department distribute child support incentive payments to counties. It is further the intent of the General Assembly that all of the State share of recoveries of amounts of support for public assistance recipients, less annual appropriations from this fund source for state child support enforcement operations, be distributed to counties, as described in Section 26-13-108, C.R.S. If the total amount of the State share of recoveries is greater than the total annual appropriations from this fund source, the Department is authorized to distribute to counties, for county incentive payments, the actual State share of any additional recoveries. 23 Department of Human Services, Division of Child Welfare -- It is the intent of the General Assembly to encourage counties to serve children in the most appropriate and least restrictive manner. For this purpose, the Department may transfer funds among all line items in this long bill group total for the Division of Child Welfare, except that the Department may not transfer funds from non-custodial line items to the Child Welfare Administration line item to increase funding for personal services. 24 Department of Human Services, Division of Child Welfare, Child Welfare Services -- It is the intent of the General Assembly that the Department may hold out up to $1,000,000 total funds in this line item for activities designed to maximize Colorado's receipt of federal funds under Title IV-E of the Social Security Act. Expenditures may include, but need not be limited to, distributions to counties for Title-IV-E-related administrative costs, incentive payments to counties for improved Title IV-E claiming, automated system changes, and/or purchase of contract services designed to help the State in maximizing Title IV-E receipts. Funds held out pursuant to this footnote shall be in addition to other amounts authorized to be held out from county child welfare services allocations. 25 Department of Human Services, Division of Child Welfare, Family and Children's Programs -- It is the intent of the General Assembly that $4,006,949 of the funds appropriated for this line item be used to assist county departments of social services in implementing and expanding family- and community-based services for adolescents. It is the intent of the General Assembly that such services be based on a program or programs that have been demonstrated to be effective in reducing the need for higher cost residential services. 26 Department of Human Services, Office of Self Sufficiency, Colorado Works Program, County Block Grants -- Pursuant to Sections 26-2-714 (7) and 26-2-714 (9), C.R.S., under certain conditions, a county may transfer federal Temporary Assistance for Needy Families (TANF) funds within its Colorado Works Program Block Grant to the federal child care development fund or to programs funded by Title XX of the federal Social Security Act. One of the conditions specified is that the amount a county transfers must be specified by the Department of Human Services as being available for transfer within the limitation imposed by federal law. It is the intent of the General Assembly that the Department allow individual counties to transfer a greater percent of federal TANF funds than the state is allowed under federal law as long as: (a) Each county has had an opportunity to transfer an amount up to the federal maximum allowed; and, (b) the total amount transferred statewide does not exceed the federal maximum. 27 Department of Human Services, Office of Self Sufficiency, Colorado Works Program, County Block Grants -- It is the intent of the General Assembly that the appropriation of local funds for Colorado Works program county block grants may be decreased by a maximum of $100,000 to reduce one or more small counties' fiscal year 2013-14 targeted or actual spending level pursuant to Section 26-2-714 (8), C.R.S. 28 Department of Human Services, Office of Self Sufficiency, Colorado Works Program, County Block Grants -- It is the intent of the General Assembly that the Department comply with the provisions of Section 26-2-714 (10), C.R.S., by reducing required county Temporary Assistance for Needy Families (TANF) maintenance of effort expenditures in the fiscal year after the State is notified that it has met federal work participation rates and qualifies for a percent reduction in the state's maintenance of effort. If the State is notified during state FY 2012-13 that it has met federal work participation rates for a prior year and therefore qualifies for a percent reduction in the state's maintenance of effort, local cash funds expenditure obligations that are established in this line item pursuant to Section 26-2-714 (6) (c) (I), C.R.S., shall be reduced by $5,524,726. 29 Department of Human Services, Behavioral Health Services, Co-occurring Behavioral Health Services -- It is the intent of the General Assembly this appropriation be used for the purpose of providing a full continuum of co-occurring behavioral health treatment services in southern Colorado and the Arkansas Valley. 30 Department of Human Services, Services for People with Disabilities, Community Services for People with Developmental Disabilities, Program Costs -- It is the intent of the General Assembly that expenditures for these services be recorded only against the Long Bill group total for Program Costs. 30a Department of Human services, Services for People with Disabilities, Community Services for People with Developmental Disabilities, Program Costs The appropriations in this subdivision assume the following caseload and cost estimates for Medicaid clients: Waiver Enrollment Full Program Equivalent Cost Per Enrollment Comprehensive 4,695 4,356.75 $65,765.91 Supported Living Services 3,217 3,098.00 $12,898.74 Children's Extensive Support 1,204 623.41 $19,929.64 Targeted Case Management 9,116 8,039.41 $2,192.62 31 Department of Human Services, Services for People with Disabilities, Community Services for People with Developmental Disabilities, Program Costs, Preventive Dental Hygiene -- It is the intent of the General Assembly that this appropriation be used to provide special dental services for persons with developmental disabilities. 32 Department of Human Services, Services for People with Disabilities, Community Services for People with Developmental Disabilities, Early Intervention Services -- It is the intent of the General Assembly that expenditures for these services be recorded only against the Long Bill group total for Early Intervention Services. 33 Department of Human Services, Services for People with Disabilities, Regional Centers for People with Developmental Disabilities -- The Department may transfer up to 5.0 percent of the total appropriation between the Wheat Ridge Regional Center, the Grand Junction Regional Center and Pueblo Regional Center. 34 Department of Human Services, Adult Assistance Programs, Other Grant Programs, Home Care Allowance; and Home Care Allowance Grant Program -- Pursuant to Section 26-2-122.4 (3), C.R.S, any amount in the Home Care Allowance Grant Program line item that is not required to operate the Grant Program may be transferred to the Home Care Allowance Program line item and used to provide additional benefits under that program. It is further the intent of the General Assembly that any amount in the home care allowance program line item that is unused may be transferred to the home care allowance grant program line item and used to provide additional benefits under that program. 35 Department of Human Services, Adult Assistance Programs, Community Services for the Elderly, Older Americans Act Programs, and State Funding for Senior Services -- Amounts in the Older Americans Act Programs line item are calculated based on a requirement for a non-federal match of at least 15 percent, including a 5.0 percent state match, pursuant to Title III of the federal Older Americans Act. The Department is authorized to transfer General Fund and cash funds from the State Funding for Senior Services line item to the Older Americans Act Programs line item to comply with the 5.0 percent state match requirement for the Older Americans Act Programs. This appropriation is based on the assumption that all federal Title III funds requiring a state match that are not for purposes of administration or included in the appropriations for other line items will be expended from the Older Americans Act Programs line item. 36 Department of Human Services, Division of Youth Corrections, Institutional Programs; and Community Programs -- The Department may transfer a total of up to $5,000,000 General Fund between line items in the Institutional Programs section and the Community Programs line items for Purchase of Contract Placements, Parole Program Services, and S.B. 91-94 Programs to facilitate the placement and treatment of youth in the most appropriate setting, to support appropriate treatment, transition, and wrap-around services for youth in residential and non-residential settings, and to support community-based alternatives to secure detention placements, except that this transfer authority may not be used to reduce the S.B. 91-94 Programs line item. SECTION 4. Appropriation. In addition to any other appropriation, there is hereby appropriated, out of any moneys in the general fund not otherwise appropriated, to the department of health care policy and financing, for the fiscal year beginning July 1, 2013, the sum of $4,500,000, or so much thereof as may be necessary, for allocation to the intellectual and developmental disabilities services cash fund created in section 25.5-10-207 (1), Colorado Revised Statutes, related to the implementation of this act. SECTION 5. Appropriation. (1) In addition to any other appropriation, there is hereby appropriated, to the department of health care policy and financing, for the fiscal year beginning July 1, 2013, the sum of $13,852 and 0.2 FTE, or so much thereof as may be necessary, for allocation to the division of intellectual and developmental disabilities for administrative expenses for renewal and redesign of medicaid home- and community-based services waivers relating to intellectual and developmental disabilities. Of said sum, $6,926(M) is from the intellectual and developmental disabilities services cash fund created in section 25.5-10-207 (1), Colorado Revised Statutes, and $6,926 is from federal funds. (2) In addition to any other appropriation, there is hereby appropriated, to the department of health care policy and financing, for the fiscal year beginning July 1, 2013, the sum of $400,000, or so much thereof as may be necessary, for allocation to the division of intellectual and developmental disabilities for contract services for renewal and redesign of medicaid home- and community-based services waivers relating to intellectual and developmental disabilities. Of said sum, $200,000(M) is from the intellectual and developmental disabilities services cash fund created in section 25.5-10-207 (1), Colorado Revised Statutes, and $200,000 is from federal funds. Any moneys appropriated in this subsection (2) not expended prior to July 1, 2014, are further appropriated to the department for the fiscal year beginning July 1, 2014, for the same purposes. (3) In addition to any other appropriation, there is hereby appropriated, out of any moneys in the intellectual and developmental disabilities services cash fund created in section 25.5-10-207 (1), Colorado Revised Statutes, not otherwise appropriated, to the department of health care policy and financing, for the fiscal year beginning July 1, 2013, the sum of $4,293,074, or so much thereof as may be necessary, for allocation to the division of intellectual and developmental disabilities for increasing system capacity for home- and community-based intellectual and developmental disabilities programs, services, and supports. Any moneys appropriated in this subsection (3) not expended prior to July 1, 2014, are further appropriated to the department for the fiscal year beginning July 1, 2014, for the same purposes. SECTION 6. Effective date. This act takes effect upon passage; except that sections 1, 4, and 5 of this act take effect March 1, 2014. SECTION 7. Safety clause. The general assembly hereby finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, and safety. ________________________________________________________ Mark Ferrandino Morgan Carroll SPEAKER OF THE HOUSE PRESIDENT OF OF REPRESENTATIVES THE SENATE ____________________________ ____________________________ Marilyn Eddins Cindi L. Markwell CHIEF CLERK OF THE HOUSE SECRETARY OF OF REPRESENTATIVES THE SENATE APPROVED________________________________________ _________________________________________ John W. Hickenlooper GOVERNOR OF THE STATE OF COLORADO