HOUSE BILL 971304
BY REPRESENTATIVES Owen, Dyer, Bacon, Chavez, Clarke, Gotlieb, Hagedorn, Keller, Leyba, Mace, Miller, Nichol, Romero, Schwarz, Snyder, Tate, Tool, Tucker, Tupa, Udall, Veiga, S. Williams, and Zimmerman;
also SENATORS Hopper, Hernandez, Martinez, Pascoe,
Reeves, Rupert, Tanner, and Wham.
CONCERNING THE CREATION OF THE CHILDREN'S BASIC HEALTH
PLAN, AND MAKING AN APPROPRIATION IN CONNECTION THEREWITH.
Be it enacted by the General Assembly of the State
of Colorado:
SECTION 1. Title
26, Colorado Revised Statutes, 1989 Repl. Vol., as amended, is
amended BY THE ADDITION OF A NEW ARTICLE to read:
ARTICLE 19
Children's Basic Health Plan
2619101. Short title.
THIS ARTICLE SHALL BE KNOWN AND MAY BE CITED AS THE "CHILDREN'S
BASIC HEALTH PLAN ACT".
2619102. Legislative declaration.
(1) THE GENERAL ASSEMBLY HEREBY FINDS AND DECLARES
THAT A SIGNIFICANT PERCENTAGE OF CHILDREN ARE UNINSURED. THIS
LACK OF HEALTH INSURANCE COVERAGE DECREASES CHILDREN'S ACCESS
TO PREVENTIVE HEALTH CARE SERVICES, COMPROMISES THE PRODUCTIVITY
OF THE STATE'S FUTURE WORKFORCE, AND RESULTS IN AVOIDABLE EXPENDITURES
FOR EMERGENCY AND REMEDIAL HEALTH CARE. HEALTH CARE PROVIDERS,
HEALTH CARE FACILITIES, AND ALL PURCHASERS OF HEALTH CARE, INCLUDING
THE STATE, BEAR THE COSTS OF THIS UNCOMPENSATED CARE.
(2) THE GENERAL ASSEMBLY FURTHER FINDS
AND DECLARES THAT THE COORDINATION AND CONSOLIDATION OF FUNDING
SOURCES CURRENTLY AVAILABLE TO PROVIDE SERVICES TO UNINSURED CHILDREN
SUCH AS THE CHILDREN'S HEALTH PLAN CREATED IN ARTICLE 17 OF THIS
TITLE, THE COLORADO INDIGENT CARE PROGRAM PURSUANT TO ARTICLE
15 OF THIS TITLE, AND OTHER CHILDREN'S HEALTH PROGRAMS WOULD EFFICIENTLY
AND EFFECTIVELY MEET THE HEALTH CARE NEEDS OF UNINSURED CHILDREN
AND WOULD HELP TO REDUCE THE VOLUME OF UNCOMPENSATED CARE IN THE
STATE.
(3) (a) IT IS THE INTENT OF THE GENERAL
ASSEMBLY TO MAKE HEALTH INSURANCE COVERAGE AFFORDABLE AND TO SUPPORT
EMPLOYERS IN THEIR EFFORTS TO PROVIDE THEIR EMPLOYEES AND THEIR
DEPENDENTS WITH HEALTH INSURANCE COVERAGE.
(b) IT IS THE INTENT OF THE GENERAL ASSEMBLY
THAT THE CHILDREN'S BASIC HEALTH PLAN CREATED BY THIS ARTICLE
BE PRIMARILY FUNDED THROUGH SAVINGS AND EFFICIENCIES REALIZED
THROUGH ACTUAL REDUCTIONS IN ADMINISTRATIVE AND PROGRAMMATIC COSTS
ASSOCIATED WITH THE IMPLEMENTATION OF THIS ARTICLE ACHIEVED IN
OTHER HEALTH CARE PROGRAMS AND NOT DECREASES IN THE NUMBER OF
CASELOADS OF SUCH PROGRAMS.
(4) IT IS NOT THE INTENT OF THE GENERAL
ASSEMBLY TO CREATE AN ENTITLEMENT FOR HEALTH INSURANCE COVERAGE.
2619103. Definitions.
AS USED IN THIS ARTICLE, UNLESS THE CONTEXT OTHERWISE REQUIRES:
(1) "CHILD" MEANS A PERSON WHO
IS LESS THAN EIGHTEEN YEARS OF AGE.
(2) "CHILDREN'S BASIC HEALTH PLAN" OR "PLAN" MEANS THE HEALTH INSURANCE PRODUCT DESIGNED BY THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING AND PROVIDED TO ENROLLEES, AS DEFINED IN THIS SECTION.
(3) "DEPARTMENT" MEANS THE DEPARTMENT
OF HEALTH CARE POLICY AND FINANCING CREATED IN SECTION 25.51104,
C.R.S.
(4) "ELIGIBLE PERSON" MEANS
A PERSON WHO IS LESS THAN EIGHTEEN YEARS OF AGE, WHOSE GROSS FAMILY
INCOME DOES NOT EXCEED ONE HUNDRED EIGHTYFIVE PERCENT OF
THE FEDERAL POVERTY LEVEL, ADJUSTED FOR FAMILY SIZE.
(5) "ENROLLEE" MEANS ANY CHILD
THAT HAS ENROLLED IN THE PLAN.
(6) "HEALTH CARE PROGRAM" MEANS
ANY HEALTH CARE PROGRAM IN THE STATE THAT IS SUPPORTED WITH STATE
GENERAL FUND OR FEDERAL DOLLARS.
(7) "SUBSIDIZED ENROLLEE" MEANS
AN ELIGIBLE PERSON WHO RECEIVES A SUBSIDY FROM THE DEPARTMENT
TO PURCHASE COVERAGE UNDER THE PLAN OR A COMPARABLE HEALTH INSURANCE.
(8) "SUBSIDY" MEANS THE AMOUNT
PAID BY THE DEPARTMENT TO ASSIST AN ELIGIBLE PERSON IN PURCHASING
COVERAGE UNDER THE PLAN OR A COMPARABLE HEALTH INSURANCE PRODUCT
AVAILABLE TO THE ELIGIBLE PERSON THROUGH ANOTHER COVERAGE ENTITY.
(9) "TRUST" MEANS THE CHILDREN'S
BASIC HEALTH PLAN TRUST CREATED IN SECTION 2619105.
2619104. Children's basic
health plan implementation required rules.
THE DEPARTMENT IS AUTHORIZED TO ADOPT RULES TO IMPLEMENT THE CHILDREN'S
BASIC HEALTH PLAN TO PROVIDE HEALTH INSURANCE COVERAGE TO CHILDREN
ON A STATEWIDE BASIS PURSUANT TO THE PROVISIONS OF THIS ARTICLE.
2619105. Trust created.
(1) A FUND TO BE KNOWN AS THE
CHILDREN'S BASIC HEALTH PLAN TRUST IS HEREBY CREATED AND ESTABLISHED
IN THE STATE TREASURY. ALL MONEYS DEPOSITED IN THE TRUST AND ALL
INTEREST EARNED ON MONEYS IN THE TRUST SHALL REMAIN IN THE TRUST
FOR THE PURPOSES SET FORTH IN THIS ARTICLE, AND NO PART THEREOF
SHALL BE EXPENDED OR APPROPRIATED FOR ANY OTHER PURPOSE. NO INVESTMENT
EARNINGS OR OTHER MONEYS IN THE TRUST SHALL BE SUBJECT TO ANY
MANAGEMENT FEE IMPOSED BY LAW FOR THE BENEFIT OF THE GENERAL FUND.
(2) ALL OR A PORTION OF THE MONEYS IN
THE TRUST SHALL BE ANNUALLY APPROPRIATED BY THE GENERAL ASSEMBLY
FOR THE PURPOSES OF THIS ARTICLE AND SHALL NOT BE TRANSFERRED
TO OR REVERT TO THE GENERAL FUND OF THE STATE AT THE END OF ANY
FISCAL YEAR.
(3) BEGINNING IN FISCAL YEAR 1998, APPROPRIATIONS
TO THE TRUST MAY BE MADE BY THE GENERAL ASSEMBLY BASED ON THE
SAVINGS ACHIEVED THROUGH REFORMS, CONSOLIDATIONS, AND STREAMLINING
OF HEALTH CARE PROGRAMS REALIZED THROUGH ACTUAL REDUCTIONS IN
ADMINISTRATIVE AND PROGRAMMATIC COSTS ASSOCIATED WITH THE IMPLEMENTATION
OF THIS ARTICLE AND NOT DECREASES IN THE NUMBER OF CASELOADS OF
SUCH PROGRAMS. BEGINNING WITH AND SUBSEQUENT TO FISCAL YEAR 1999,
THESE APPROPRIATIONS MAY BE BASED ON THE ANNUAL SAVINGS REPORT
DESCRIBED IN SECTION 2619106.
(4) AS PART OF ITS ANNUAL SAVINGS REPORT
TO THE GENERAL ASSEMBLY ON NOVEMBER 1 OF EACH YEAR, THE DEPARTMENT
MAY IDENTIFY EFFICIENCIES AND CONSOLIDATIONS THAT PRODUCE SAVINGS
IN THE DEPARTMENT'S ANNUAL BUDGET REQUEST THAT RESULT IN ACTUAL
REDUCTIONS IN ADMINISTRATIVE AND PROGRAMMATIC COSTS ASSOCIATED
WITH THE IMPLEMENTATION OF THIS ARTICLE AND NOT DECREASES IN THE
NUMBER OF CASELOADS OF SUCH PROGRAMS. THESE IDENTIFIED SAVINGS
SHALL NOT DUPLICATE THE SAVINGS REPORTED IN THE ANNUAL SAVINGS
REPORT DESCRIBED IN SECTION 2619106. IF THE GENERAL
ASSEMBLY DETERMINES THAT THE SAVINGS IDENTIFIED PURSUANT TO THIS
SUBSECTION (4) ARE VALID, IT IS THE INTENT OF THE GENERAL ASSEMBLY
THAT SUCH SAVINGS MAY BE APPROPRIATED TO THE CHILDREN'S BASIC
HEALTH PLAN TRUST.
(5) THE DEPARTMENT MAY RECEIVE PAYMENT
FOR COVERAGE OFFERED AND MAY RECEIVE OR CONTRACT FOR DONATIONS,
GIFTS, AND GRANTS FROM ANY SOURCE. SUCH FUNDS SHALL BE TRANSMITTED
TO THE STATE TREASURER WHO SHALL CREDIT THE SAME TO THE TRUST.
THE DEPARTMENT MAY EXPEND SUCH FUNDS FROM THE TRUST FOR THE PURPOSES
OF THIS ARTICLE.
2619106. Annual savings
report. (1) BY NOVEMBER 1 OF
EACH YEAR, THE DEPARTMENT SHALL SUBMIT TO THE JOINT BUDGET COMMITTEE
OF THE GENERAL ASSEMBLY AND TO THE OFFICE OF STATE PLANNING AND
BUDGETING AN ANNUAL SAVINGS REPORT STATING THE COSTSAVINGS
ANTICIPATED IN THE PREVIOUS, CURRENT, AND SUBSEQUENT FISCAL YEARS
FROM HEALTH CARE PROGRAM REFORMS, CONSOLIDATIONS, AND STREAMLINING.
(2) THE ANNUAL SAVINGS REPORT SHALL INCLUDE
A DESCRIPTION OF NET SAVINGS FACTORING IN INCREASED ADMINISTRATIVE
EXPENSES FROM THE FOLLOWING:
(a) Enrollment of medicaid clients
in medicaid managed care programs. IN CALCULATING SAVINGS
FROM ENROLLMENT OF MEDICAID CLIENTS INTO MEDICAID MANAGED CARE
PROGRAMS, THE DEPARTMENT SHALL CALCULATE THE TOTAL ANNUAL SAVINGS
FROM GROWTH IN MANAGED CARE ENROLLMENT SUBSEQUENT TO JUNE 30,
1997.
(b) Consolidation of the children's
portions of the Colorado indigent care program into the plan.
IN CALCULATING THE SAVINGS ACCRUED AND ANTICIPATED FROM CONSOLIDATION
OF THE CHILDREN'S PORTIONS OF THE COLORADO INDIGENT CARE PROGRAM,
CREATED IN ARTICLE 15 OF THIS TITLE, INTO THE PLAN, THE DEPARTMENT
SHALL USE THE FOLLOWING METHODOLOGY: ESTIMATE THE REDUCTION IN
EXPENDITURES DUE TO THE REDUCTION IN THE NUMBER OF CHILDREN UNDER
AGE EIGHTEEN SERVED BY THE COLORADO INDIGENT CARE PROGRAM FOR
EACH FISCAL YEAR IN WHICH CHILDREN HAVE BEEN ENROLLED IN THE CHILDREN'S
BASIC HEALTH PLAN.
(3) AS REPORTED IN THE ANNUAL SAVINGS
REPORT, THE TOTAL SAVINGS FROM CONSOLIDATION OF THE CHILDREN'S
PORTIONS OF THE COLORADO INDIGENT CARE PROGRAM, CREATED IN ARTICLE
15 OF THIS TITLE, INTO THE PLAN SHALL NOT REDUCE THE REIMBURSEMENT
RATE OF EXPENDITURES MADE ON BEHALF OF CHILDREN TO THE COLORADO
INDIGENT CARE PROGRAM ENROLLED PROVIDERS BELOW THE REIMBURSEMENT
RATES USED IN THE FISCAL YEAR PRIOR TO THE FIRST CHILD ENROLLING
IN THE PLAN.
(4) THE DEPARTMENT SHALL MODIFY TOTAL
SAVINGS CALCULATED IN PARAGRAPH (b) OF SUBSECTION (2) OF THIS
SECTION ACCORDING TO THE GEOGRAPHIC RESIDENCE OF SUBSIDIZED ENROLLEES
AND TO THE PROBABLE LOCATION OF THEIR HEALTH CARE PROVIDERS UNDER
THE COLORADO INDIGENT CARE PROGRAM, CREATED IN ARTICLE 15 OF THIS
TITLE.
(5) THE GENERAL ASSEMBLY SHALL MAKE APPROPRIATIONS
TO THE TRUST BASED ON THE SAVINGS CALCULATED IN PARAGRAPH (b)
OF SUBSECTION (2) OF THIS SECTION TWELVE MONTHS AFTER THE PLAN
BEGINS PROVIDING A BENEFIT PACKAGE THAT INCLUDES INPATIENT CARE
AND ANNUALLY THEREAFTER.
2619107. Duties of the
department schedule of services premiums
copayments subsidies. (1) IN
ADDITION TO ANY OTHER DUTIES PURSUANT TO THIS ARTICLE, THE DEPARTMENT
SHALL HAVE THE FOLLOWING DUTIES:
(a) TO DESIGN, ON OR AFTER JULY 1, 1998,
AND FROM TIME TO TIME REVISE, A SCHEDULE OF HEALTH CARE SERVICES
INCLUDED IN THE PLAN, INCLUDING, BUT NOT LIMITED TO, PREVENTIVE
CARE, PHYSICIAN SERVICES, INPATIENT AND OUTPATIENT HOSPITAL SERVICES,
PRESCRIPTION DRUGS AND MEDICATIONS, AND OTHER SERVICES THAT MAY
BE MEDICALLY NECESSARY FOR THE HEALTH OF ENROLLEES. THE DEPARTMENT
SHALL DESIGN AND REVISE THIS SCHEDULE OF HEALTH CARE SERVICES
INCLUDED IN THE PLAN TO BE SIMILAR TO THE BASIC AND STANDARD HEALTH
BENEFIT PLANS DEFINED IN SECTION 1016102 (4) AND (42),
C.R.S.
(b) TO DESIGN AND IMPLEMENT A STRUCTURE
OF PERIODIC PREMIUMS DUE TO THE DEPARTMENT OR TO MANAGED CARE
PLANS FROM ENROLLEES THAT IS BASED ON A SLIDING FEE SCALE. THE
SLIDING FEE SCALE SHALL BE DEVELOPED BASED ON THE PER CAPITA COST
OF THE PLAN AND THE ENROLLEE'S GROSS FAMILY INCOME DURING THE
PREVIOUS THREE MONTHS. AS PERMITTED BY FEDERAL AND STATE LAW,
ENROLLEES IN THE PLAN MAY USE FUNDS FROM A MEDICAL SAVINGS ACCOUNT
TO PAY PREMIUMS. ON OR BEFORE NOVEMBER 1 OF EACH YEAR, THE DEPARTMENT
SHALL SUBMIT FOR APPROVAL TO THE JOINT BUDGET COMMITTEE ITS PROPOSAL
FOR A SCALE FOR INCREASING PREMIUMS OR SERVICE COST SHARING FOR
THE PLAN BASED UPON A FAMILY'S INCOME.
(c) TO DESIGN AND IMPLEMENT A STRUCTURE
OF COPAYMENTS DUE TO PROVIDERS OF MANAGED HEALTH CARE PLANS FROM
ENROLLEES. ENROLLEES IN THE PLAN MAY USE FUNDS FROM A MEDICAL
SAVINGS ACCOUNT TO PAY COPAYMENTS.
(d) TO DESIGN DETAILED RULES OF ELIGIBILITY
AND ENROLLMENT PROCESSES FOR THE PLAN;
(e) TO DESIGN A PROCEDURE WHEREBY A FINANCIAL
SPONSOR MAY PAY THE PREMIUM OR SOME PORTION THEREOF ON BEHALF
OF A SUBSIDIZED OR NONSUBSIDIZED ENROLLEE; EXCEPT THAT THE PAYMENT
MADE ON BEHALF OF SAID ENROLLEE SHALL NOT EXCEED THE TOTAL PREMIUMS
DUE FROM THE ENROLLEE;
(f) TO DESIGN A PROCEDURE WHEREBY THE
PLAN MAY PAY SUBSIDIES FOR ELIGIBLE PERSONS TO PURCHASE COVERAGE
UNDER THE PLAN OR A COMPARABLE HEALTH INSURANCE PRODUCT;
(g) TO ESTABLISH CRITERIA TO ALLOW A MANAGED
CARE PLAN, THE DEPARTMENT, OR SOME OTHER ENTITY TO VERIFY ELIGIBILITY
PURSUANT TO SECTION 2619109.
(2) THE DEPARTMENT IS AUTHORIZED TO INSTITUTE
A PROGRAM FOR COMPETITIVE BIDDING PURSUANT TO SECTION 24103202
OR 24103203, C.R.S., FOR PROVIDING MEDICAL SERVICES
ON A MANAGED CARE BASIS FOR CHILDREN UNDER THIS ARTICLE. THE DEPARTMENT
IS AUTHORIZED TO SELECT MORE THAN ONE MANAGED CARE CONTRACTOR.
TO THE EXTENT THAT THE DEPARTMENT DETERMINES THAT THERE IS A UNIQUE
COMMUNITYBASED ORGANIZATION THAT IS ABLE TO PERFORM THE
NEW FUNCTIONS REQUIRED UNDER THIS ARTICLE, THE DEPARTMENT MAY
SELECT SUCH CONTRACTOR PURSUANT TO SECTION 24103205,
C.R.S., AND RULES PROMULGATED BY THE DEPARTMENT TO ADMINISTER
ALL OR A PORTION OF THE CHILDREN'S BASIC HEALTH PLAN ACCORDING
TO SECTION 2619111. IN ADDITION TO SUCH CONTRACTOR,
THE DEPARTMENT MAY ENTER INTO CONTRACTS, AS NECESSARY, WITH THE
ADMINISTRATOR OF THE COLORADO CHILDREN'S HEALTH PLAN TO CARRY
OUT THE PURPOSES OF THIS ARTICLE.
2619108. Financial management.
(1) THE DEPARTMENT SHALL PROMULGATE RULES TO IMPLEMENT
FINANCIAL MANAGEMENT OF THE PLAN. THE DEPARTMENT SHALL ADJUST
BENEFIT LEVELS, ELIGIBILITY GUIDELINES, AND ANY OTHER MEASURE
TO ENSURE THAT SUFFICIENT FUNDS ARE PRESENT TO IMPLEMENT THE PROVISIONS
OF THIS ARTICLE.
(2) THE DEPARTMENT SHALL MAKE A QUARTERLY
ASSESSMENT OF THE EXPECTED EXPENDITURES FOR THE PLAN FOR THE REMAINDER
OF THE CURRENT BIENNIUM AND FOR THE FOLLOWING BIENNIUM. THE ESTIMATED
EXPENDITURES, INCLUDING MINIMUM RESERVE REQUIREMENTS SHALL BE
COMPARED TO AN ESTIMATE OF THE REVENUES THAT WILL BE DEPOSITED
IN THE TRUST FUND. BASED ON THIS COMPARISON, THE DEPARTMENT SHALL
MAKE ADJUSTMENTS AS NECESSARY TO ENSURE THAT EXPENDITURES REMAIN
WITHIN THE LIMITS OF AVAILABLE REVENUES FOR THE REMAINDER OF THE
CURRENT BIENNIUM AND THE FOLLOWING BIENNIUM.
(3) THE DEPARTMENT MAY, IN ADDITION TO
ANY OTHER MEASURE IT DETERMINES TO BE NECESSARY, DECREASE PREMIUM
SUBSIDIES OR LIMIT ENROLLMENT IN THE PLAN TO ENSURE THAT THE TRUST
RETAINS SUFFICIENT FUNDS PURSUANT TO SUBSECTION (1) OF THIS SECTION.
(4) NOTHING IN THIS ARTICLE OR ANY RULES
PROMULGATED PURSUANT TO THE PLAN SHALL BE INTERPRETED TO CREATE
A LEGAL ENTITLEMENT IN ANY PERSON TO COVERAGE UNDER THE PLAN.
ENROLLMENT IN THE PLAN SHALL BE LIMITED BASED UPON ANNUAL APPROPRIATIONS
MADE OUT OF THE TRUST BY THE GENERAL ASSEMBLY AS DESCRIBED IN
SECTION 2619105 AND ANY GRANTS AND DONATIONS. THE
GENERAL ASSEMBLY SHALL ANNUALLY ESTABLISH MAXIMUM ENROLLMENT FIGURES
FOR SUBSIDIZED CHILDREN. SUCH ENROLLMENT CAPS SHALL NOT BE EXCEEDED
BY THE DEPARTMENT REGARDLESS OF WHETHER THE FUNDING COMES FROM
ANNUAL APPROPRIATIONS OR GRANTS AND DONATIONS. WHEN ENROLLMENT
IN THE PLAN MUST BE LIMITED PURSUANT TO THIS SUBSECTION (4), THE
DEPARTMENT SHALL GIVE PRIORITY TO CHILDREN WHO WOULD QUALIFY FOR
MEDICAID AS IF THERE WERE NO ASSET TESTING AND TO CHILDREN WITH
GROSS FAMILY INCOMES UNDER ONE HUNDRED THIRTYTHREE PERCENT
OF THE FEDERAL POVERTY LEVEL.
2619109. Eligibility.
(1) TO BE ELIGIBLE FOR A SUBSIDY, A CHILD MUST NOT
HAVE CURRENTLY NOR IN THE THREE MONTHS PRIOR TO APPLICATION FOR
THE PLAN HAVE BEEN INSURED BY A COMPARABLE HEALTH PLAN THROUGH
AN EMPLOYER, WITH THE EMPLOYER CONTRIBUTING AT LEAST FIFTY PERCENT
OF THE PREMIUM COST. CHILDREN WHO HAVE LOST INSURANCE COVERAGE
DUE TO A CHANGE IN OR LOSS OF EMPLOYMENT SHALL NOT BE SUBJECT
TO THE WAITING PERIOD.
(2) IF ONE CHILD FROM A FAMILY IS ENROLLED
IN THE PLAN, ALL CHILDREN MUST BE ENROLLED, UNLESS THE OTHER CHILDREN
HAVE ALTERNATIVE HEALTH INSURANCE COVERAGE.
(3) CHILDREN WITH GROSS FAMILY INCOMES THAT EXCEED ONE HUNDRED EIGHTYFIVE PERCENT OF THE FEDERAL POVERTY GUIDELINES MAY ENROLL IN THE PLAN, BUT ARE NOT ELIGIBLE FOR SUBSIDIES FROM THE DEPARTMENT.
(4) CHILDREN WHO ARE DETERMINED TO BE
ELIGIBLE FOR THE PLAN SHALL REMAIN ELIGIBLE FOR TWELVE MONTHS
SUBSEQUENT TO THE LAST DAY OF THE MONTH IN WHICH THEY WERE ENROLLED.
2619110. Participation
by managed care plans. (1) MANAGED
CARE PLANS, AS DEFINED IN SECTION 1016102 (26.5),
C.R.S., THAT PARTICIPATE IN THE PLAN SHALL DO SO BY CONTRACT WITH
THE DEPARTMENT AND SHALL PROVIDE THE HEALTH CARE SERVICES COVERED
BY THE PLAN TO EACH ENROLLEE.
(2) MANAGED CARE PLANS PARTICIPATING IN
THE PLAN SHALL NOT DISCRIMINATE AGAINST ANY POTENTIAL OR CURRENT
ENROLLEE BASED UPON HEALTH STATUS, SEX, RACE, ETHNICITY, OR RELIGION.
(3) MANAGED CARE PLANS THAT CONTRACT WITH
THE DEPARTMENT TO PROVIDE THE PLAN TO ENROLLEES SHALL ALSO BE
WILLING TO CONTRACT WITH THE MEDICAID MANAGED CARE PROGRAM, AS
ADMINISTERED BY THE DEPARTMENT.
(4) THE DEPARTMENT MAY RECEIVE AND ACT
UPON COMPLAINTS FROM ENROLLEES REGARDING FAILURE TO PROVIDE COVERED
SERVICES OR EFFORTS TO OBTAIN PAYMENT, OTHER THAN AUTHORIZED COPAYMENTS,
FOR COVERED SERVICES DIRECTLY FROM ELIGIBLE RECIPIENTS.
(5) PARENTS OR GUARDIANS OF CHILDREN SHALL
CHOOSE A PARTICIPATING HEALTH MAINTENANCE ORGANIZATION BEFORE
ENROLLING IN THE PLAN IN AREAS OF THE STATE WHERE A PARTICIPATING
HEALTH MAINTENANCE ORGANIZATION IS AVAILABLE. THE DEPARTMENT WILL
ASSIGN CHILDREN WHO ARE CURRENTLY ENROLLED IN THE PLAN AND WHOSE
PARENTS OR GUARDIANS HAVE NOT SELECTED A HEALTH MAINTENANCE ORGANIZATION
WITHIN A TIME PERIOD DETERMINED BY THE DEPARTMENT TO A PARTICIPATING
HEALTH MAINTENANCE ORGANIZATION WITH THE CHILD'S PRIMARY CARE
PHYSICIAN IN THE NETWORK. THE DEPARTMENT SHALL SEEK TO MAINTAIN
CONTINUITY OF THE HEALTH PLAN BETWEEN MEDICAID AND THE CHILDREN'S
BASIC HEALTH PLAN.
(6) THE DEPARTMENT SHALL ALLOW, AT LEAST
ANNUALLY, AN OPPORTUNITY FOR ENROLLEES TO TRANSFER AMONG PARTICIPATING
MANAGED CARE PLANS SERVING THEIR RESPECTIVE GEOGRAPHIC REGIONS.
THE DEPARTMENT SHALL ESTABLISH A PERIOD OF AT LEAST TWENTY DAYS
ANNUALLY WHEN THIS OPPORTUNITY IS AFFORDED ELIGIBLE RECIPIENTS.
IN GEOGRAPHIC REGIONS SERVED BY MORE THAN ONE PARTICIPATING MANAGED
CARE PLAN, THE DEPARTMENT SHALL ENDEAVOR TO ESTABLISH A UNIFORM
PERIOD FOR SUCH OPPORTUNITY.
(7) THE DEPARTMENT SHALL MAKE A PREMIUM
RATE PAYMENT TO MANAGED CARE PLANS BASED UPON A DEFINED SCOPE
OF SERVICES. THE DEPARTMENT SHALL ONLY USE MARKET RATE BIDS THAT
DO NOT DISCRIMINATE AND ARE ADEQUATE TO ASSURE QUALITY, NETWORK
SUFFICIENCY, AND LONGTERM COMPETITIVENESS IN THE CHILDREN'S
BASIC HEALTH PLAN MANAGED CARE MARKET. THE DEPARTMENT SHALL RETAIN
A QUALIFIED ACTUARY TO ESTABLISH A LOWER LIMIT FOR SUCH BIDS.
A CERTIFICATION BY SUCH ACTUARY TO THE APPROPRIATE LOWER LIMIT
SHALL BE CONCLUSIVE EVIDENCE OF THE DEPARTMENT'S COMPLIANCE WITH
THE REQUIREMENTS OF THIS SUBSECTION (7). FOR THE PURPOSES OF THIS
SUBSECTION (7), A "QUALIFIED ACTUARY" SHALL BE A PERSON
DEEMED AS SUCH UNDER REGULATIONS PROMULGATED BY THE COMMISSIONER
OF INSURANCE.
(8) ALL MANAGED CARE PLANS PARTICIPATING
IN THE PLAN SHALL MEET STANDARDS REGARDING THE QUALITY OF SERVICES
TO BE PROVIDED, FINANCIAL INTEGRITY, AND RESPONSIVENESS TO THE
UNMET HEALTH CARE NEEDS OF CHILDREN THAT MAY BE SERVED.
2619111. Department
privatization. (1) THE GENERAL
ASSEMBLY FINDS THAT THE CHILDREN'S BASIC HEALTH PLAN IS A PROGRAM
UNDER WHICH THE PRIVATE SECTOR HAS A GREAT DEAL OF EXPERIENCE
IN MAKING VARIOUS HEALTH CARE PLANS AVAILABLE TO THE PRIVATE SECTOR
AND SERVING AS THE LIAISON BETWEEN LARGE EMPLOYERS AND HEALTH
CARE PROVIDERS, INCLUDING BUT NOT LIMITED TO HEALTH MAINTENANCE
ORGANIZATIONS. THE GENERAL ASSEMBLY THEREFORE DETERMINES THAT
THE CHILDREN'S BASIC HEALTH PLAN INVOLVES DUTIES SIMILAR TO DUTIES
CURRENTLY OR PREVIOUSLY PERFORMED BY STATE EMPLOYEES BUT IS DIFFERENT
IN SCOPE AND POLICY OBJECTIVES FROM THE STATE MEDICAL ASSISTANCE
PROGRAM.
(2) PURSUANT TO SECTION 2450504
(2) (a), C.R.S., THE DEPARTMENT SHALL ENTER INTO PERSONAL SERVICES
CONTRACTS THAT CREATE AN INDEPENDENT CONTRACTOR RELATIONSHIP FOR
THE ADMINISTRATION OF THE CHILDREN'S BASIC HEALTH PLAN, INCLUDING
OUTREACH, MARKETING, ELIGIBILITY DETERMINATION, AND ENROLLMENT.
THE DEPARTMENT MAY ENTER INTO ADDITIONAL PERSONAL SERVICES CONTRACTS
FOR OTHER ADMINISTRATIVE FUNCTIONS REQUIRED BY THIS ARTICLE.
(3) THE IMPLEMENTATION OF THIS SECTION
IS CONTINGENT UPON A FINDING BY THE STATE PERSONNEL DIRECTOR THAT
ANY OF THE CONDITIONS OF SECTION 2450504 (2), C.R.S.,
HAVE BEEN MET OR THAT THE CONDITIONS OF SECTION 2450503
(1), C.R.S., HAVE BEEN MET.
2619112. Authority to the
department to apply for federal waivers.
THE DEPARTMENT IS HEREBY AUTHORIZED AND REQUIRED TO APPLY FOR
ANY FEDERAL WAIVERS NECESSARY TO IMPLEMENT THE PURPOSES OF THIS
ARTICLE.
SECTION 2. 2617103
(5), Colorado Revised Statutes, 1989 Repl. Vol., as amended, is
amended to read:
2617103. Definitions.
As used in this article, unless the context otherwise requires:
(5) "Eligible persons" means
children who are less than thirteen
EIGHTEEN years of age, who are eligible under the medically indigent
program established in article 15 of this title or are eligible
under one of the programs specified in section 2617107.5,
who are not eligible for medical assistance under the medical
assistance program pursuant to article 4 of this title, and who
are not otherwise insured for the covered services.
SECTION 3. 2617105
(2), Colorado Revised Statutes, 1989 Repl. Vol., as amended, is
repealed as follows:
2617105. Powers and duties
of administrator. (2) The
board shall divide the state into regions based upon the number
of eligible persons and the number of provider resources. The
administrator may select a region of the state for the initial
operation of the plan, taking into account the levels and rates
of unemployment in different areas of the state, the unmet need
for basic health care services to a population reasonably representative
of the portion of the state's population that lacks such coverage,
and the need for geographic, demographic, and economic diversity.
Any expansion of the program to additional regions of the state
in subsequent years shall be subject to approval by the general
assembly.
SECTION 4. Appropriation
adjustment in 1997 Long Bill. (1) In
addition to any other appropriation for the fiscal year beginning
July 1, 1996, there is hereby appropriated, out of any moneys
in the general fund not otherwise appropriated, to the children's
basic health plan trust created in section 2619105,
Colorado Revised Statutes, the sum of two million dollars ($2,000,000).
(2) In addition to any other appropriation
for the fiscal year beginning July 1, 1997, there is hereby appropriated,
to the department of health care policy and financing, medical
programs, other medical programs, out of any moneys in the children's
basic health plan trust fund, the sum of two million dollars ($2,000,000),
or so much thereof as may be necessary for the implementation
of this act.
(3) For the implementation of this act,
a lettered note designation made in the annual general appropriation
act shall be modified as follows: The lettered note associated
with the department of higher education, regents of the university
of Colorado health sciences center, Colorado child health plan
shall be modified to show that the sum of two million three hundred
seventyfour thousand five hundred seventy dollars ($2,374,570)
shall be from program reserves and from moneys received from the
department of health care policy and financing.
SECTION 5. 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