SENATE 3rd Reading Unamended April 14, 2006 SENATE Amended 2nd Reading April 13, 2006Second Regular Session Sixty-fifth General Assembly STATE OF COLORADO REENGROSSED This Version Includes All Amendments Adopted in the House of Introduction LLS NO. 06-0143.01 Michele Hanigsberg SENATE BILL 06-044 SENATE SPONSORSHIP Hagedorn, and Shaffer HOUSE SPONSORSHIP Boyd, and Green Senate Committees House Committees Health and Human Services Appropriations A BILL FOR AN ACT Concerning the provision of health care services to specified low-income adults, and making an appropriation therefor. Bill Summary (Note: This summary applies to this bill as introduced and does not necessarily reflect any amendments that may be subsequently adopted.) Interim Committee on Health Insurance. Establishes the Colorado primary care program ("program") for the purpose of providing primary care services to specified low-income, uninsured adults who have a qualifying medical condition. Defines who is eligible for the program. Specifies the primary care services that may be provided to an eligible person, subject to available appropriations. Requires the department of health care policy and financing ("department") to contract with federally qualified health centers for the provision of all primary care services to eligible persons enrolled in the program. Requires the department to propose rules for approval by the medical services board to implement financial management of the program. Requires the general assembly to annually establish maximum enrollment figures for eligible persons in the program. Authorizes the department to establish a waiting list for the program when enrollment in the program must be limited. Establishes the Colorado health care services fund ("fund"), which shall annually consist of $15 million of the moneys in the general fund exempt account. For fiscal years 2006-07 to 2010-11, specifies that $ 7.5 million of the moneys in the fund shall be appropriated for the program and $7.5 million of the moneys in the fund shall be appropriated to pay for services provided to specified medicaid eligible adults who are above 60% of the federal poverty level. Contains a reporting requirement. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Legislative declaration. (1) The general assembly finds and declares that: (a) Many uninsured Coloradans use hospital emergency rooms for either basic health care services or for the treatment of illnesses that if treated earlier would have been considerably less expensive. (b) Uncompensated care is reflected in an increase in hospital charges, which shifts the cost of care to the health insurance companies. (c) In order to reduce this cost-shifting and to provide better care for uninsured Coloradans, additional resources need to be targeted to primary care services in the state. (d) The increase in the provision of primary care services will reduce the use of hospital emergency rooms by uninsured Coloradans for nonemergency care. (e) A reduction in uncompensated hospital care, specifically in emergency rooms, will decrease the financial losses of hospitals, which should decrease the cost-shift to the health insurance companies; this outcome should be reflected in a decrease in individual health insurance premiums. (2) The general assembly, therefore, supports an increase in funding for primary care services and encourages the executive branch regulatory agencies to monitor the cost-shifting occurring within Colorado's health care system. SECTION 2. 26-15-104, Colorado Revised Statutes, is amended to read: 26-15-104. Program for the medically indigent established - eligibility - rules. (1) A program for the medically indigent is hereby established, to commence July 1, 1983, which shall be administered by the department of health care policy and financing, to provide payment to providers for the provision of medical services to eligible persons who are medically indigent. The department of health care policy and financing may promulgate such rules and regulations as are necessary for the implementation of this part 1 in accordance with article 4 of title 24, C.R.S. (2) A client's eligibility to receive discounted services under the program for the medically indigent shall be determined by rule of the state board based on a specified percentage of the federal poverty level, adjusted for family size, which percentage shall not be less than two hundred fifty percent. SECTION 3. 26-15-106 (1), Colorado Revised Statutes, is amended, and the said 26-15-106 is further amended BY THE ADDITION OF A NEW SUBSECTION, to read: 26-15-106. Responsibility of the department of health care policy and financing - provider reimbursement. (1) The state department shall be responsible for: (a) Execution of such contracts with providers for partial reimbursement of costs for medical services rendered to the medically indigent as the state department shall determine are necessary for the program; (b) Promulgation of such reasonable rules as are necessary for the program; and (c) Submission of the report required in section 26-15-105; and (d) Application for all available federal financial participation under the program. (20) After receiving approval by the state department, a community health clinic may utilize moneys received pursuant to this article, and any gifts, grants, and donations for the development and implementation of demonstration projects that may include but need not be limited to coordination of care and disease management. SECTION 4. Article 15 of title 26, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read: 26-15-114. Health care services fund - creation. (1) (a) There is hereby created in the state treasury the Colorado health care services fund, referred to in this section as the "fund". The fund shall consist of moneys credited thereto pursuant to this section. (b) In fiscal year 2005-06, the general assembly shall appropriate fifteen million sixty-two thousand four hundred eight dollars from the general fund to the fund. In fiscal year 2007-08 and each of the two fiscal years thereafter, fifteen million dollars of the moneys in the general fund exempt account created in section 24-77-103.6 (2), C.R.S., shall be appropriated by the general assembly to the fund. (c) All moneys appropriated to the fund shall be used as provided in this section and shall not be deposited in or transferred to the general fund of this state or to any other fund. Notwithstanding any provision of section 24-36-114, C.R.S., to the contrary, all interest derived from the deposit and investment of moneys in the fund shall be credited to the fund. (2) (a) In fiscal year 2006-07, and each of the three fiscal years thereafter, notwithstanding the requirements of section 26-15-106 (9) (b), the moneys deposited into the fund shall be appropriated to community health clinics and primary care clinics operated by a licensed or certified health care facility to provide primary care services to low-income adults pursuant to this article. (b) Of the moneys appropriated pursuant to paragraph (a) of this subsection (2), eighteen percent of the moneys annually appropriated shall be to Denver health and hospitals as the community health clinic provider for the city and county of Denver. SECTION 5. Appropriation - adjustment to the 2005 long bill. (1) For the implementation of this act, appropriations to the department of health care policy and financing, indigent care program, the children's hospital, clinic based indigent care, for the fiscal year beginning July 1, 2005, shall be decreased by thirty million one hundred twenty-four thousand eight hundred sixteen dollars ($30,124,816). Of said sum, fifteen million sixty-two thousand four hundred eight dollars ($15,062,408) shall be from the general fund and fifteen million sixty-two thousand four hundred eight dollars ($15,062,408) shall be from federal funds. (2) In addition to any other appropriation, for the fiscal year beginning July 1, 2005, there is hereby appropriated, out of any moneys in the general fund not otherwise appropriated, to the Colorado health care services fund, created in section 26-15-114 (1) (a), Colorado Revised Statutes, the sum of fifteen million sixty-two thousand four hundred eight dollars ($15,062,408). SECTION 6. Appropriation - adjustment to the 2006 long bill. (1) For the implementation of this act, appropriations made in the annual general appropriation act to the department of health care policy and financing for the fiscal year beginning July 1, 2006, shall be adjusted as follows: (a) The cash funds exempt appropriation for the indigent care program, safety net provider payments, is increased by two million seven hundred eleven thousand two hundred thirty-three dollars ($2,711,233). Said sum shall be from the Colorado health care services fund, created in section 26-15-114 (1) (a), Colorado Revised Statutes. (b) The appropriation for the indigent care program, the children's hospital, clinic based indigent care, is increased by twenty-four million seven hundred two thousand three hundred forty-nine dollars ($24,702,349). Of said sum, twelve million three hundred fifty-one thousand one hundred seventy-five dollars ($12,351,175) shall be from the Colorado health care services fund, created in section 26-15-114 (1) (a), Colorado Revised Statutes, and twelve million three hundred fifty-one thousand one hundred seventy-four dollars ($12,351,174) shall be from federal funds. 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.