HOUSE BILL 971063
BY REPRESENTATIVES Snyder, Allen, Clarke, Hagedorn, Keller, Nichol, Tate, and Veiga;
also SENATOR Wham.
CONCERNING CERTAIN REVISIONS TO STATUTES RELATING
TO THE "COLORADO MEDICAL ASSISTANCE ACT", AND MAKING
AN APPROPRIATION IN CONNECTION THEREWITH.
Be it enacted by the General Assembly of the State
of Colorado:
SECTION 1. Part
5 of article 4 of title 26, Colorado Revised Statutes, 1989 Repl.
Vol., as amended, is amended BY THE ADDITION OF A NEW SECTION
to read:
264509.2. Children's personal
assistance services and family support program.
(1) THE GENERAL ASSEMBLY FINDS THAT MANY FAMILIES WHO
ATTEMPT TO CARE FOR SEVERELY DISABLED OR TERMINALLY ILL CHILDREN
AT HOME OFTEN ARE BURDENED WITH THE EXCESSIVE FINANCIAL AND PERSONAL
COSTS OF PROVIDING CONTINUOUS CARE. PRIVATE INSURANCE COMPANIES
RARELY SUPPORT ESSENTIAL, LONGTERM CUSTODIAL SERVICES AND
OFTEN ESTABLISH MONETARY LIMITS THAT ARE WELL BELOW THE LEVELS
REQUIRED BY THESE DISABLED CHILDREN. WHEN COVERAGE IS AVAILABLE,
CARE IS FREQUENTLY PROVIDED IN A MEDICAL MODEL THAT IS MARGINALLY
APPROPRIATE TO THE NEEDS OF THE CHILDREN AND THE FAMILY AND USUALLY
MORE EXPENSIVE TO THE PAYOR. THE RESULTING PRESSURES OFTEN CONTRIBUTE
TO FAMILY DISINTEGRATION AND INCREASED DEPENDENCY ON PUBLIC PROGRAMS.
THE GENERAL ASSEMBLY FINDS THAT IT IS IN THE BEST INTERESTS OF
THE CITIZENS OF THE STATE TO ENCOURAGE THE PRESERVATION OF FAMILIES
WITH CHILDREN WITH DISABILITIES.
(2) AS USED IN THIS SECTION, UNLESS THE
CONTEXT OTHERWISE REQUIRES, "ELIGIBLE DISABLED CHILDREN"
MEANS CHILDREN EIGHTEEN YEARS OF AGE OR YOUNGER:
(a) WHO HAVE MEDICAL NEEDS THAT, PURSUANT
TO STATE DEPARTMENT RULES, WOULD QUALIFY THEM FOR INSTITUTIONALIZATION
OR PLACE THEM AT RISK OF INSTITUTIONALIZATION IN AN ACUTE CARE
HOSPITAL OR NURSING FACILITY;
(b) WHO HAVE GROSS INCOMES, INCLUDING
THE AMOUNT OF PARENTAL INCOME AND RESOURCES TO BE ATTRIBUTED TO
THE CHILD'S GROSS INCOME ACCORDING TO RULES TO BE PROMULGATED
BY THE MEDICAL SERVICES BOARD, THAT DO NOT EXCEED THREE HUNDRED
PERCENT OF THE CURRENT FEDERAL SUPPLEMENTAL SECURITY INCOME BENEFIT
LEVEL;
(c) WHO ARE NOT RECEIVING LONGTERM
SERVICES FROM ANY ALTERNATIVE WAIVER PROGRAM ESTABLISHED UNDER
THIS TITLE;
(d) FOR WHOM A LICENSED PHYSICIAN HAS
CERTIFIED THAT INHOME CARE IS AN APPROPRIATE WAY TO MEET
THE CHILD'S NEEDS; AND
(e) FOR WHOM THE COST OF CARE OUTSIDE
OF THE INSTITUTION IS NO HIGHER THAN THE ESTIMATED MEDICAID COST
OF APPROPRIATE INSTITUTIONAL CARE.
(3) THERE IS HEREBY ESTABLISHED IN THE
STATE DEPARTMENT THE CHILDREN'S PERSONAL ASSISTANCE SERVICES AND
FAMILY SUPPORT WAIVER PROGRAM, REFERRED TO IN THIS SECTION AS
THE "PROGRAM", TO PROVIDE SERVICES TO ELIGIBLE DISABLED
CHILDREN IN THEIR HOMES RATHER THAN IN THE CONFINES OF AN ACUTE
CARE HOSPITAL OR NURSING FACILITY. THE NUMBER OF CHILDREN ENROLLED
IN THIS PROGRAM OR ANY OTHER MODEL 200 PROGRAM SHALL NOT EXCEED
THE STATE DEPARTMENT'S ABILITY TO COVER THE COSTS OF THE PROGRAMS
WITHIN THE ANNUAL APPROPRIATIONS FOR THIS PROGRAM AND ANY OTHER
MODEL 200 PROGRAM.
(4) PRIORITY FOR PARTICIPATION IN THE
PROGRAM SHALL BE GIVEN FIRST TO CHILDREN WHO ARE ON THE WAITING
LIST FOR OTHER MODEL 200 PROGRAMS AND SECONDLY TO CHILDREN WHOSE
PARENTS WILL RETURN TO WORK IF APPROPRIATE CARE FOR THEIR DISABLED
CHILD IS PROVIDED UNDER THE PROGRAM. SPACES IN THE PROGRAM SHALL
ALSO BE AVAILABLE TO CHILDREN WHO WERE ALREADY COVERED BY MEDICAID
BUT WHO WERE RENDERED TEMPORARILY INELIGIBLE FOR A PERIOD OF NOT
MORE THAN THREE MONTHS DUE TO A PERIODIC OR CYCLICAL PEAK IN THEIR
PARENTS' INCOME.
(5) THE MEDICAL SERVICES BOARD SHALL ADOPT
RULES TO GOVERN THE PROGRAM CONSISTENT WITH ANY FEDERAL WAIVERS
INCLUDING, BUT NOT LIMITED TO, RULES CONCERNING:
(a) SERVICES THAT ARE REIMBURSABLE UNDER
THIS SECTION INCLUDING, BUT NOT LIMITED TO:
(I) RESPITE CARE, TO THE DEGREE ITS ADDITIONAL
COST IS OFFSET BY COLLECTION OF A PARENTAL COPAYMENT;
(II) CASE MANAGEMENT; AND
(III) MEDICALLY NECESSARY PROFESSIONAL
OR COMMUNITY SERVICES BEYOND THOSE SPECIFIED IN SECTION 264202
OR 264302, TO THE DEGREE THAT THEY PROVIDE A COSTEFFECTIVE
AND MEDICALLY APPROPRIATE ALTERNATIVE TO COVERED SERVICES;
(b) PROVIDER SELECTION AND CERTIFICATION;
(c) DOCUMENTATION FOR ASSESSMENT AND RECERTIFICATION;
(d) CASE MANAGEMENT AGENCY SELECTION AND
RESPONSIBILITY; AND
(e) REIMBURSEMENT.
(6) IF THE STATE DEPARTMENT FINDS IT
COSTEFFECTIVE AND ALL NECESSARY FEDERAL WAIVERS ARE OBTAINED,
PARENTS OF ELIGIBLE DISABLED CHILDREN MAY BE AUTHORIZED TO HIRE
AND MANAGE CARE PROVIDERS FROM CERTIFIED MEDICAID AGENCIES. CASE
MANAGEMENT AGENCIES SHALL WORK WITH PARENTS TO DEVELOP THE SKILLS
NECESSARY FOR ONGOING CARE MANAGEMENT.
(7) THE STATE DEPARTMENT IS AUTHORIZED
TO SEEK WAIVERS FROM THE FEDERAL GOVERNMENT TO QUALIFY FOR FEDERAL
FINANCIAL PARTICIPATION IN THE PROGRAM.
(8) THE STATE DEPARTMENT IS AUTHORIZED
TO CHARGE AND COLLECT COPAYMENTS FROM PARENTS FOR SERVICES RENDERED.
(9) THE STATE DEPARTMENT IS DIRECTED TO
STUDY THE ADVISABILITY OF SETTING AN UPPER LIMIT ON PARENTAL INCOME
FOR PARTICIPATION IN THIS PROGRAM AND OTHER CHILDREN'S MEDICAID
WAIVER PROGRAMS. ON OR BEFORE NOVEMBER 1, 1997, THE STATE DEPARTMENT
SHALL REPORT ITS FINDINGS AND RECOMMENDATIONS TO THE JOINT BUDGET
COMMITTEE OF THE GENERAL ASSEMBLY.
SECTION 2. 264303
(1), Colorado Revised Statutes, 1989 Repl. Vol., as amended, is
amended BY THE ADDITION OF A NEW PARAGRAPH to read:
264303. Optional programs
with special state provisions. (1) This
section specifies programs developed by Colorado to increase federal
financial participation through selecting optional services or
optional eligible groups. These programs include but are not limited
to:
(m) THE CHILDREN'S PERSONAL ASSISTANCE
SERVICES AND FAMILY SUPPORT WAIVER PROGRAM, AS SPECIFIED IN SECTION
264509.2.
SECTION 3. 264606
(3), Colorado Revised Statutes, 1989 Repl. Vol., as amended, is
repealed as follows:
264606. Eligible groups.
(3) A person eligible for
home and communitybased services for the developmentally
disabled, as such person is described in section 264623
(2), shall not be eligible for home and communitybased services
for the elderly, blind, and disabled pursuant to this subpart
1, unless the need for such services is primarily due to physical
impairments that are not caused by any diagnosis included in the
definition of developmental disability.
SECTION 4. 264302
(1) (f), Colorado Revised Statutes, 1989 Repl. Vol., as amended,
is amended to read:
264302. Basic services
for the categorically needy optional services.
(1) The following are services for which federal financial
participation is available and which Colorado has selected to
provide as optional services under the medical assistance program:
(f) Prosthetic devices, except
that such devices shall be limited to surgically implanted devices
INCLUDING MEDICALLY NECESSARY AUGMENTATIVE COMMUNICATION DEVICES;
EXCEPT THAT, NONSURGICALLY IMPLANTED PROSTHETIC DEVICES SHALL
BE INCLUDED ONLY AFTER JULY 1, 1998, AND ONLY IF THE GENERAL ASSEMBLY
APPROVES APPROPRIATIONS FOR THESE DEVICES AS A NEW BENEFIT.
SECTION 5. 264403
(1) (a) (I), Colorado Revised Statutes, 1989 Repl. Vol., as amended,
is amended, and the said 264403 (1) (a) is further
amended BY THE ADDITION OF A NEW SUBPARAGRAPH, to read:
264403. Recoveries
overpayments penalties interest adjustments
liens. (1) (a) (I) Except
as provided in section 264403.3 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 medical services 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 264518
(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.
(III) (A) WHEN A THIRD PARTY IS PRIMARILY
LIABLE FOR THE PAYMENT OF THE COSTS OF A RECIPIENT'S MEDICAL BENEFITS,
PRIOR TO RECEIVING NONEMERGENCY MEDICAL CARE, THE RECIPIENT SHALL
COMPLY WITH THE PROTOCOLS OF THE THIRD PARTY, INCLUDING USING
PROVIDERS WITHIN THE THIRD PARTY'S NETWORK OR RECEIVING A REFERRAL
FROM THE RECIPIENT'S PRIMARY CARE PHYSICIAN. ANY RECIPIENT FAILING
TO FOLLOW THE THIRD PARTY'S PROTOCOLS IS LIABLE FOR THE PAYMENT
OR COST OF ANY CARE OR SERVICES THAT THE THIRD PARTY WOULD HAVE
BEEN LIABLE TO PAY; EXCEPT THAT, IF THE THIRD PARTY OR THE SERVICE
PROVIDER SUBSTANTIVELY FAILS TO COMMUNICATE THE PROTOCOLS TO THE
RECIPIENT, THE ITEMS OR SERVICES ARE NONREIMBURSABLE UNDER THIS
ARTICLE AND THE RECIPIENT IS NOT LIABLE TO THE PROVIDER.
(B) A RECIPIENT MAY ENTER INTO A WRITTEN
AGREEMENT WITH A THIRD PARTY OR PROVIDER UNDER WHICH THE RECIPIENT
AGREES TO PAY FOR ITEMS PROVIDED OR SERVICES RENDERED THAT ARE
OUTSIDE OF THE NETWORK OR PLAN PROTOCOLS. THE RECIPIENT'S AGREEMENT
TO BE PERSONALLY LIABLE FOR SUCH NONEMERGENCY, NONREIMBURSABLE
ITEMS SHALL BE RECORDED ON FORMS APPROVED BY THE MEDICAL SERVICES
BOARD AND SIGNED AND DATED BY BOTH THE RECIPIENT AND THE PROVIDER
IN ADVANCE OF THE SERVICES BEING RENDERED.
SECTION 6. Repeal. 264504
(2) (b) (II), Colorado Revised Statutes, 1989 Repl. Vol., as amended,
is repealed.
SECTION 7. Appropriation. In addition to any other appropriation, there is hereby appropriated, to the department of health care policy and financing, medical programs, administration, for the fiscal year beginning July 1, 1997, the sum of twentytwo thousand four hundred dollars ($22,400), or so much thereof as may be necessary, for the implementation of this act. Of said sum, five thousand six hundred dollars ($5,600) shall be from the general fund and subject to the "(M)" notation as defined in the general appropriation act, and sixteen thousand eight hundred dollars ($16,800) shall be from matching federal funds.
SECTION 8. 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.
____________________________ ____________________________
Charles E. Berry Tom Norton
SPEAKER OF THE HOUSE PRESIDENT OF
OF REPRESENTATIVES THE SENATE
____________________________ ____________________________
Judith M. Rodrigue Joan M. Albi
CHIEF CLERK OF THE HOUSE SECRETARY OF
OF REPRESENTATIVES THE SENATE
APPROVED________________________________________
_________________________________________
Roy Romer
GOVERNOR OF THE STATE OF COLORADO