Second Regular Session Sixty-fifth General Assembly STATE OF COLORADO INTRODUCED 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 A BILL FOR AN ACT Concerning the provision of health care services to specified low-income adults. 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. Title 25.5, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW ARTICLE to read: ARTICLE 4 Colorado Primary Care 25.5-4-101. Short title. This article shall be known and may be cited as the "Colorado Primary Care Act". 25.5-4-102. Definitions. As used in this article, unless the context otherwise requires: (1) "Eligible person" means a person who is: (a) A resident of Colorado and who is a citizen of the United States or a qualified alien as defined in section 26-2-703 (17.7), C.R.S.; (b) At least nineteen years of age and less than sixty-four years of age; (c) At or below one hundred percent of the federal poverty level; (d) Not eligible for medical assistance pursuant to article 4 of title 26, C.R.S., or the children's basic health plan pursuant to article 19 of title 26, C.R.S., or enrolled in health insurance coverage from any other third-party payor; and (e) Not eligible for veteran's administration medical benefits or the treatment of the qualifying medical condition through workers' compensation coverage. (2) "Primary care" means the basic, entry-level health care provided by health care practitioners or non-physician health care practitioners that is generally provided in an outpatient setting. (3) "Program" means the Colorado primary care program. (4) "Qualifying medical condition" means a condition that requires a plan of care and at least four visits annually to a medical care provider. 25.5-4-103. Colorado primary care - benefits - providers. (1) There is hereby created the Colorado primary care program for the purpose of providing primary care services to low-income, uninsured adults who have a qualifying medical condition. The state department shall administer and implement the program consistent with the provisions of this article. (2) Subject to available appropriations, an eligible person may receive the following primary care services when enrolled in the program: (a) Office visits for acute and chronic health care conditions; (b) Age and gender appropriate health care screenings; (c) Laboratory tests for baseline studies as well as tests needed to diagnose or treat medical conditions; (d) Basic x-rays; (e) Outpatient drug and alcohol treatment as prescribed by the participating medical care provider; (f) Diabetic care, including medical supplies; (g) Four prescriptions per month that are written by an authorized provider; and (h) Any other primary care service the state board authorizes by rule that is medically necessary for the eligible person to receive and that is within the program's annual appropriation. (3) The state department shall contract with federally qualified health centers for the provision of all primary care services to eligible persons enrolled in the program. 25.5-4-104. Financial management - rules. (1) The state department shall propose rules for approval by the state board to implement financial management of the program. Pursuant to such rules, the state department shall adjust benefit levels and provider reimbursement to ensure that sufficient funds are present to implement the provisions of this article. The department shall develop and use quality assurance measures to ensure that appropriate health care outcomes are met. (2) (a) Nothing in this article or any rules promulgated pursuant to this article shall be interpreted to create a legal entitlement in any person to coverage under the program. Enrollment in the program shall be limited based upon annual appropriations made by the general assembly and any gifts, grants, and donations received by the state department. The general assembly shall annually establish maximum enrollment figures for eligible persons in the program. The enrollment caps shall not be exceeded by the state department regardless of whether the funding comes from annual appropriations or gifts, grants, and donations. When enrollment in the program must be limited pursuant to this subsection (2), the state department shall establish a waiting list for the program. (b) The department shall report quarterly to the joint budget committee on any enrollment caps that have been instituted for the program and the number of eligible persons who are on the waiting list. (3) The state board shall promulgate rules necessary to implement and administer this article that shall include, but not be limited to, an appeal process for the program, quality assurance measures for providers participating in the program, and financial management of the program. 25.5-4-105. Report. On or before July 1, 2007, the state department shall report to the joint health and human services committees of the senate and the house of representatives on the use of the moneys in the health care services fund established in section 25.5-1-114 and the implementation and operation of the Colorado primary care program. SECTION 2. Part 1 of article 1 of title 25.5, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read: 25.5-1-114. Health care services fund - creation. (1) (a) There is hereby created in the state treasury the Colorado health care services fund, also 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, and each of the four fiscal years thereafter, if the most recent legislative council staff economic and revenue forecast estimates that the general fund exempt account, created in section 24-77-103.6 (2), C.R.S., will receive more than one hundred fifteen million dollars, fifteen million dollars of the moneys in the general fund exempt account shall be appropriated to the Colorado health care services fund created in this subsection (1). (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) In fiscal year 2006-07, and each of the four fiscal years thereafter, of the moneys deposited into the fund: (a) Seven million five hundred thousand dollars shall be appropriated for the Colorado primary care program established in article 4 of this title; and (b) (I) Seven million five hundred thousand dollars shall be appropriated to increase eligibility in the medical assistance program pursuant to section 26-4-301 (1) (u), C.R.S. (II) The moneys specified in this paragraph (b) shall be used only to pay for services provided to persons in the eligibility category specified in section 26-4-301 (1) (u), C.R.S., who are above sixty percent of the federal poverty level. SECTION 3. Effective date. This act shall take effect July 1, 2006. SECTION 4. 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.