HOUSE BILL 981325
BY REPRESENTATIVES Owen, Grampsas, Romero, Bacon, Clarke, Dyer, Gordon, Grossman, Hagedorn, Leyba, Mace, Morrison, Nichol, Reeser, Saliman, Snyder, Takis, Tate, Tupa, Udall, Veiga, S. Williams, and Zimmerman;
also SENATORS Rizzuto, Blickensderfer, Lacy, Bishop,
Feeley, Hernandez, Hopper, Matsunaka, Norton, Pascoe, Reeves,
Rupert, Tanner, Weddig, and Wham.
CONCERNING THE IMPLEMENTATION OF THE NONMEDICAID
STATE SUBSIDIZED INSURANCE PROGRAM KNOWN AS THE "CHILDREN'S
BASIC HEALTH PLAN".
Be it enacted by the General Assembly of the State
of Colorado:
SECTION 1. 2619102,
Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW
SUBSECTION to read:
2619102. Legislative declaration.
(5) THE GENERAL ASSEMBLY HEREBY DECLARES THAT THE
FOLLOWING PRINCIPLES SHALL BE USED IN IMPLEMENTING THE CHILDREN'S
BASIC HEALTH PLAN SET FORTH IN THIS ARTICLE:
(a) THE CHILDREN'S BASIC HEALTH PLAN POLICY
BOARD CREATED IN THIS ARTICLE SHALL ESTABLISH AND MAINTAIN A GOAL
OF INTERPROGRAM COMMUNICATION IN ORDER TO MAXIMIZE EXISTING
STATE APPROPRIATIONS FOR THE POPULATION SERVED IN THE PROGRAM;
(b) THERE SHALL BE EFFICIENT PROGRAM UTILIZATION
THROUGH INTERPROGRAM COORDINATION AND PROGRAM CONSOLIDATION,
AND WHERE APPROPRIATE, THROUGH CONTRACTING WITH THE PRIVATE SECTOR
AND WITH ESSENTIAL COMMUNITY PROVIDERS;
(c) THE POLICIES ENACTED IN HOUSE BILL
971304 REGARDING A STRONG MANAGED CARE DIRECTION SHALL BE
EMPHASIZED;
(d) THE PRIVATE SECTOR SHALL BE INVOLVED
TO THE GREATEST POSSIBLE DEGREE;
(e) THERE SHALL BE A STRONG EMPHASIS ON
COORDINATION WITH LOCAL AND STATE PUBLIC HEALTH PROGRAMS AND INITIATIVES
FOR CHILDREN.
SECTION 2. 2619103
(1) and (4), Colorado Revised Statutes, are amended, and the said
2619103 is further amended BY THE ADDITION OF THE
FOLLOWING NEW SUBSECTIONS, to read:
2619103. Definitions.
As used in this article, unless the context otherwise requires:
(1) "Child" means a person who
is less than eighteen
NINETEEN years of age.
(4) "Eligible person" means
a person who is less than eighteen
NINETEEN years of age, whose gross family income does not exceed
one hundred eightyfive percent of the federal poverty level,
adjusted for family size.
(5.4) "ESSENTIAL COMMUNITY PROVIDER"
MEANS A HEALTH CARE PROVIDER THAT:
(a) HAS HISTORICALLY SERVED MEDICALLY
NEEDY OR MEDICALLY INDIGENT PATIENTS AND DEMONSTRATES A COMMITMENT
TO SERVE LOWINCOME AND MEDICALLY INDIGENT POPULATIONS WHO
MAKE UP A SIGNIFICANT PORTION OF ITS PATIENT POPULATION, OR IN
THE CASE OF A SOLE COMMUNITY PROVIDER, SERVES THE MEDICALLY INDIGENT
PATIENTS WITHIN ITS MEDICAL CAPABILITY; AND
(b) WAIVES CHARGES OR CHARGES FOR SERVICES
ON A SLIDING SCALE BASED ON INCOME AND DOES NOT RESTRICT ACCESS
OR SERVICES BECAUSE OF A CLIENT'S FINANCIAL LIMITATIONS.
(6.5) "POLICY BOARD" MEANS THE
CHILDREN'S BASIC HEALTH PLAN POLICY BOARD CREATED IN SECTION 2619104.5.
SECTION 3. 2619104,
Colorado Revised Statutes, is amended to read:
2619104. Children's basic
health plan implementation required rules.
The department
POLICY BOARD is authorized to adopt rules to implement AND ADMINISTER
the children's basic health plan to provide health insurance coverage
to children on a statewide basis pursuant to the provisions of
this article.
SECTION 4. Article
19 of title 26, Colorado Revised Statutes, is amended BY THE ADDITION
OF THE FOLLOWING NEW SECTIONS to read:
2619104.5. Policy board
creation repeal. (1) THERE
IS HEREBY CREATED IN THE DEPARTMENT OF HEALTH CARE POLICY AND
FINANCING THE CHILDREN'S BASIC HEALTH PLAN POLICY BOARD, WHICH
SHALL EXERCISE ITS POWERS AND PERFORM ITS DUTIES AND FUNCTIONS
AS IF IT WERE TRANSFERRED TO SAID DEPARTMENT BY A TYPE 1
TRANSFER. THE POLICY BOARD SHALL CONSIST OF ELEVEN MEMBERS.
FOUR MEMBERS OF THE POLICY BOARD SHALL BE THE EXECUTIVE DIRECTORS
OF THE DEPARTMENTS OF PUBLIC HEALTH AND ENVIRONMENT, HEALTH CARE
POLICY AND FINANCING, EDUCATION, AND HUMAN SERVICES, OR THEIR
DESIGNEES. SEVEN MEMBERS OF THE POLICY BOARD SHALL BE APPOINTED
BY THE GOVERNOR, WITH THE CONSENT OF THE SENATE, AND SHALL REPRESENT
THE FOLLOWING: TWO MEMBERS SHALL REPRESENT SMALL BUSINESS OR
OTHER BUSINESSES IN THE STATE; THREE MEMBERS SHALL REPRESENT THE
HEALTH CARE INDUSTRY, INCLUDING ONE WHO IS A MANAGED CARE EXPERT
NOT AFFILIATED WITH A MANAGED CARE ORGANIZATION UNDER CONTRACT
TO PROVIDE SERVICES UNDER THE CHILDREN'S BASIC HEALTH PLAN; ONE
MEMBER SHALL BE A REPRESENTATIVE OF AN ESSENTIAL COMMUNITY PROVIDER;
AND ONE MEMBER SHALL BE A CONSUMER.
(2) THE APPOINTED MEMBERS OF THE POLICY
BOARD SHALL SERVE TERMS OF FOUR YEARS; EXCEPT THAT THE INITIAL
TERMS OF ONE OF THE BUSINESS REPRESENTATIVES AND ONE OF THE HEALTH
CARE INDUSTRY MEMBERS SHALL BE THREE YEARS. WHENEVER A VACANCY
EXISTS, THE GOVERNOR SHALL APPOINT A MEMBER FOR THE REMAINING
PORTION OF THE UNEXPIRED TERM CREATED BY THE VACANCY. THE GOVERNOR
MAY REMOVE ANY APPOINTED MEMBER OF THE POLICY BOARD FOR ANY CAUSE
THAT RENDERS SUCH A MEMBER INCAPABLE OR UNFIT TO DISCHARGE THE
DUTIES OF THE OFFICE.
(3) THIS SECTION IS REPEALED, EFFECTIVE
JULY 1, 2000.
2619104.6. Policy board
power and duties reports.
(1) IN ADDITION TO ANY OTHER POWERS ENUMERATED IN
THIS ARTICLE, THE POLICY BOARD SHALL HAVE THE FOLLOWING POWERS
AND DUTIES:
(a) TO REPORT PERIODICALLY TO THE JOINT
BUDGET COMMITTEE ON THE PROGRESS MADE IN INTERPROGRAM COORDINATION
AND PROGRAM CONSOLIDATION WITH EXISTING HEALTH CARE PROGRAMS AND
ON THE EFFICIENCIES ACHIEVED IN UTILIZING EXISTING HEALTH CARE
PROGRAMS PURSUANT TO THIS ARTICLE;
(b) TO REPORT ON MATTERS THE POLICY BOARD
DEEMS TO BE OF INTEREST TO THE GENERAL ASSEMBLY REGARDING THE
IMPLEMENTATION AND ADMINISTRATION OF THE CHILDREN'S BASIC HEALTH
PLAN; AND
(c) TO REPORT ON ENROLLMENT, UTILIZATION,
AND QUALITY OF HEALTH CARE SERVICES PROVIDED THROUGH THE CHILDREN'S
BASIC HEALTH PLAN, AND IDENTIFY BARRIERS RELATED TO ENROLLMENT,
UTILIZATION, AND QUALITY.
(2) IN ADDITION TO THE REPORTS SUBMITTED
TO THE JOINT BUDGET COMMITTEE PURSUANT TO SUBSECTION (1) OF THIS
SECTION, THE POLICY BOARD SHALL CONDUCT AN EVALUATION OF THE CONTRACTING
AND ADMINISTRATIVE FUNCTIONS AND THE METHODOLOGY USED BY THE DEPARTMENT
IN IMPLEMENTING THE CHILDREN'S BASIC HEALTH PLAN AND SHALL MAKE
RECOMMENDATIONS REGARDING ANY NECESSARY CHANGES TO THE PROGRAM
OR THE STATUTES, INCLUDING ANY RECOMMENDATIONS REGARDING FURTHER
PRIVATIZATION OF THESE FUNCTIONS. SUCH EVALUATION SHALL INCLUDE
STATE FISCAL YEARS 199798 AND 199899. THE POLICY
BOARD SHALL SUBMIT A WRITTEN REPORT OF ITS EVALUATION AND RECOMMENDATIONS
ON OR BEFORE OCTOBER 1, 1999, TO THE JOINT BUDGET COMMITTEE AND
TO THE HEALTH, ENVIRONMENT, WELFARE, AND INSTITUTIONS COMMITTEES
OF THE HOUSE OF REPRESENTATIVES AND THE SENATE.
(3) THE DEPARTMENT SHALL SUBMIT TO THE
POLICY BOARD ANY INFORMATION CONCERNING THE IMPLEMENTATION AND
ADMINISTRATION OF THE CHILDREN'S BASIC HEALTH PLAN THAT IS REQUESTED
BY THE POLICY BOARD IN CONNECTION WITH ITS REPORTING AND EVALUATION
DUTIES OUTLINED IN THIS SECTION.
2619104.7. Advisory board
appointment repeal. (1) THE
EXECUTIVE DIRECTOR OF THE DEPARTMENT OF HEALTH CARE POLICY AND
FINANCING MAY APPOINT AN ADVISORY BOARD FOR THE PURPOSE OF ADVISING
THE POLICY BOARD AND THE DEPARTMENT ON THE IMPLEMENTATION AND
ADMINISTRATION OF THE CHILDREN'S BASIC HEALTH PLAN. THE NUMBER
OF PERSONS APPOINTED TO SERVE ON THE ADVISORY BOARD SHALL BE DETERMINED
BY THE EXECUTIVE DIRECTOR.
(2) THIS SECTION IS REPEALED, EFFECTIVE
JULY 1, 2000.
SECTION 5. 2619106
(1) and (2) (b), Colorado Revised Statutes, are amended to read:
2619106. Annual savings
report. (1) By November
1 OCTOBER 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:
(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
NINETEEN served by the Colorado indigent care program for each
fiscal year in which children have been enrolled in the children's
basic health plan.
SECTION 6. 2619107
(1) (a), (1) (d), and (2), Colorado Revised Statutes, are amended
to read:
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, THE EFFECTIVE DATE OF THIS
SECTION, and from time to time revise, a schedule of health care
services included in the plan including,
AND TO PROPOSE SAID SCHEDULE TO THE POLICY BOARD FOR APPROVAL
OR MODIFICATION. THE SCHEDULE OF HEALTH CARE SERVICES AS PROPOSED
BY THE DEPARTMENT AND APPROVED BY THE POLICY BOARD, SHALL INCLUDE,
but SHALL not BE 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.
(d) To design AND PROPOSE TO THE POLICY
BOARD FOR ADOPTION detailed rules of eligibility and enrollment
processes for the plan;
(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
SHALL select more than one managed care contractor TO SERVE COUNTIES
IN WHICH THERE ARE PROVIDERS CONTRACTING WITH MORE THAN ONE MANAGED
CARE PLAN. IN COUNTIES WHERE THERE IS ONLY ONE OPERATIONAL MANAGED
CARE PLAN, THE DEPARTMENT MAY CONTRACT WITH THAT MANAGED CARE
PLAN TO SERVE CHILDREN ENROLLED IN THE PLAN. 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
POLICY BOARD 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. THE POLICY
BOARD SHALL ASSURE THE UTILIZATION OF ESSENTIAL COMMUNITY PROVIDERS
FOR THE PROVISION OF SERVICES INCLUDING ELIGIBILITY DETERMINATION,
ENROLLMENT, AND OUTREACH WHEN REASONABLE. THE DEPARTMENT SHALL
CONTRACT WITH MANAGED CARE ORGANIZATIONS FOR THE DELIVERY OF HEALTH
SERVICES PURSUANT TO THIS ARTICLE. THE DEPARTMENT MAY CONTRACT
WITH ESSENTIAL COMMUNITY PROVIDERS FOR HEALTH CARE SERVICES IN
AREAS OF THE STATE THAT ARE NOT ADEQUATELY SERVED BY MANAGED CARE
ORGANIZATIONS.
SECTION 7. 2619108
(1), Colorado Revised Statutes, is amended to read:
2619108. Financial management.
(1) The department
POLICY BOARD shall promulgate rules to implement financial management
of the plan. PURSUANT TO SUCH RULES, 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.
SECTION 8. 2619109
(3), Colorado Revised Statutes, is amended to read:
2619109. Eligibility.
(3) THE DEPARTMENT MAY ESTABLISH PROCEDURES SUCH THAT
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.
SECTION 9. 2619110,
Colorado Revised Statutes, is amended BY THE ADDITION OF THE FOLLOWING
NEW SUBSECTIONS to read:
2619110. Participation
by managed care plans participation of essential community
providers. (3.5) (a) MANAGED
CARE PLANS SHALL BE SELECTED BY THE DEPARTMENT TO PARTICIPATE
IN THE CHILDREN'S BASIC HEALTH PLAN BASED UPON THE MANAGED CARE
PLANS' ASSURANCES AND THE DEPARTMENT'S VERIFICATION THAT THE MANAGED
CARE PLAN IS UTILIZING WITHIN ITS NETWORK ESSENTIAL COMMUNITY
PROVIDERS TO THE EXTENT THAT THIS ACTION DOES NOT RESULT IN A
NET INCREASE IN THE COST FOR PROVIDING SERVICES TO THE MANAGED
CARE PLAN.
(b) THE MANAGED CARE ORGANIZATION SHALL
SEEK PROPOSALS FROM EACH ESSENTIAL COMMUNITY PROVIDER IN A COUNTY
IN WHICH THE MANAGED CARE ORGANIZATION IS ENROLLING RECIPIENTS
FOR THOSE SERVICES THAT THE MANAGED CARE ORGANIZATION PROVIDES
OR INTENDS TO PROVIDE AND THAT AN ESSENTIAL COMMUNITY PROVIDER
PROVIDES OR IS CAPABLE OF PROVIDING. TO ASSIST MANAGED CARE ORGANIZATIONS
IN SEEKING PROPOSALS, THE STATE DEPARTMENT SHALL PROVIDE MANAGED
CARE ORGANIZATIONS WITH A LIST OF ESSENTIAL COMMUNITY PROVIDERS
IN EACH COUNTY. THE MANAGED CARE ORGANIZATION SHALL CONSIDER
SUCH PROPOSALS IN GOOD FAITH AND SHALL, WHEN DEEMED REASONABLE
BY THE MANAGED CARE ORGANIZATION BASED ON THE NEEDS OF ITS ENROLLEES,
CONTRACT WITH ESSENTIAL COMMUNITY PROVIDERS. EACH ESSENTIAL COMMUNITY
PROVIDER SHALL BE WILLING TO NEGOTIATE ON REASONABLY EQUITABLE
TERMS WITH EACH MANAGED CARE ORGANIZATION. ESSENTIAL COMMUNITY
PROVIDERS MAKING PROPOSALS UNDER THIS SUBSECTION (3.5) SHALL BE
ABLE TO MEET THE CONTRACTUAL REQUIREMENTS OF THE MANAGED CARE
ORGANIZATION. THE REQUIREMENT OF THIS SUBSECTION (3.5) SHALL
NOT APPLY TO A MANAGED CARE ORGANIZATION IN AREAS IN WHICH THE
MANAGED CARE ORGANIZATION OPERATES ENTIRELY AS A GROUP MODEL HEALTH
MAINTENANCE ORGANIZATION.
(c) ANY DISPUTES BETWEEN A MANAGED CARE
ORGANIZATION AND AN ESSENTIAL COMMUNITY PROVIDER THAT CANNOT BE
RESOLVED THROUGH GOOD FAITH NEGOTIATIONS MAY BE RESOLVED THROUGH
AN INFORMAL REVIEW BY THE STATE DEPARTMENT AT THE REQUEST OF ONE
OF THE PARTIES, OR THROUGH THE STATE DEPARTMENT'S AGGRIEVED PROVIDER
APPEAL PROCESS IN ACCORDANCE WITH SECTION 25.51107
(2), C.R.S., IF REQUESTED BY ONE OF THE PARTIES.
(d) IN SELECTING MANAGED CARE ORGANIZATIONS
THROUGH COMPETITIVE BIDDING, THE STATE DEPARTMENT SHALL GIVE PREFERENCE
TO THOSE MANAGED CARE ORGANIZATIONS THAT HAVE EXECUTED CONTRACTS
FOR SERVICES WITH ONE OR MORE ESSENTIAL COMMUNITY PROVIDERS.
IN SELECTING MANAGED CARE ORGANIZATIONS, THE STATE DEPARTMENT
SHALL NOT PENALIZE A MANAGED CARE ORGANIZATION FOR PAYING COSTBASED
REIMBURSEMENT TO FEDERALLY QUALIFIED HEALTH CENTERS AS DEFINED
IN THE "SOCIAL SECURITY ACT".
(5.5) IN AREAS OF THE STATE IN WHICH A
PARTICIPATING MANAGED CARE PLAN DOES NOT HAVE PROVIDERS, THE DEPARTMENT
MAY CONTRACT WITH ESSENTIAL COMMUNITY PROVIDERS AND OTHER HEALTH
CARE PROVIDERS TO PROVIDE HEALTH CARE SERVICES UNDER THE CHILDREN'S
BASIC HEALTH PLAN USING A MANAGED CARE MODEL SO LONG AS SUCH CONTRACT
DOES NOT RESULT IN ADDITIONAL COSTS TO THE STATE.
SECTION 10. 264113
(7) (a), Colorado Revised Statutes, is amended to read:
264113. Statewide managed
care system implementation required repeal.
(7) Annual savings report and use of savings.
(a) By September 1
OCTOBER 1 of each year, the state department shall submit to the
joint budget committee, the health, environment, welfare, and
institutions committee of the senate, the health, environment,
welfare, and institutions committee of the house of representatives,
and to the office of state planning and budgeting a savings report
stating the cost savings realized or anticipated in the previous,
current, and subsequent state fiscal years from enrollment of
recipients in managed care programs pursuant to the provisions
of this subpart 2. The report shall include an assessment of
the extent to which the program described in subsection (8) of
this section has reduced providers' uncompensated burdens and
an assessment of changes on the financial viability of essential
community providers. The report shall also include a recommendation
for prioritizing between the subsidized insurance program described
in subsection (8) of this section and the grants programs described
in subsection (9) of this section, and for prioritizing resources
within each of those programs to different populations and regions
of the state. These recommendations shall be based upon quantitative
and qualitative assessments of needs and on the relative costeffectiveness
of different resource allocations.
SECTION 11. 2617102,
Colorado Revised Statutes, is amended to read:
2617102. Legislative declaration.
The general assembly finds that affordable ambulatory
HEALTH care for lowincome children who are not eligible
for medicaid and are not otherwise insured is of vital concern
for the welfare of such children. This lack of basic health care
coverage is detrimental to the health of lowincome children
and to the public welfare, and results in substantial expenditures
for emergency and remedial health care, often at the expense of
health care providers, health care facilities, and all purchasers
of health care, including the state. The use of managed health
care systems has significant potential to reduce the growth of
health care costs incurred by the people of this state. Therefore,
the general assembly finds that a more costeffective and
efficient means of providing ambulatory
HEALTH care for lowincome children is necessary for the
preservation of the health of its citizenry. The children's health
plan created in this article exists only to the extent of available
appropriations, as well as to the extent of the individual provider
facility's physical, staff, and financial capabilities.
SECTION 12. 2617103
(1), (4), (5), and (7), Colorado Revised Statutes, are amended
to read:
2617103. Definitions.
As used in this article, unless the context otherwise requires:
(1) "Administrator" means the
program administrator of the Colorado health sciences center who
is responsible for the administration of the medically
indigent program pursuant to article 15 of this title
CHILDREN'S HEALTH PLAN PURSUANT TO THIS ARTICLE.
(4) "Covered services" means
outpatient
pediatric medical services, including, but not limited to, well
child care checkups, immunizations, screening laboratory tests,
visits for acute care for illnesses and injury, ongoing care for
chronic illness, MENTAL HEALTH CARE SERVICES, and outpatient surgical
AND INPATIENT services. The term does not include hospital
services, nursing home or intermediate
care facility services, mental health services
dental services. or chemical dependency
services.
(5) "Eligible persons" means
children who are less than eighteen
NINETEEN 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.
(7) "Enrollment fee" means a
one time annual payment
PAYMENTS, based upon the medically indigent program adjusted annual
family income, which an eligible person makes to the plan prior
to enrollment TO ENROLL in the plan.
SECTION 13. 2617104,
Colorado Revised Statutes, is amended to read:
2617104. Children's health
plan established administration.
The children's health plan is established to promote access to
appropriate primary
health care to assure healthy children. The plan shall provide
children's health care services to eligible persons through managed
health care systems as provided in this article. The plan shall
be administered by the administrator, as defined in section 2617103
(1).
SECTION 14. 2617107,
Colorado Revised Statutes, is amended to read:
2617107. Application procedures.
Applications and other information shall be made available to
provider offices, local human services agencies, head start programs,
school districts, public and private elementary schools in which
twentyfive percent or more of the students receive free
or reduced price lunches, community health offices, and women,
infants, and children (WIC) program sites. These sites may accept
applications, collect the enrollment fee
FEES, and forward the forms and fees to the administrator. Otherwise,
applicants may apply directly to the administrator. The administrator
may use individuals' social security numbers as identifiers for
purposes of administering the plan and conduct data matches to
verify income. Applicants shall submit evidence of family income,
earned and unearned, that will be used to verify income eligibility.
Notwithstanding any other law to the contrary, benefits under
this article are secondary to a plan of insurance or benefit program
under which an eligible person may have coverage. The administrator
shall identify eligible persons who may have coverage or benefits
under other plans of insurance or who become eligible for medical
assistance.
SECTION 15. 2617108
(1), Colorado Revised Statutes, is amended to read:
2617108. Enrollment fee
children's health plan cash fund state contribution
client copayment. (1) An
annual enrollment fee of twentyfive dollars for each eligible
child, not to exceed one hundred fifty dollars per family, is
ENROLLMENT FEES THAT FOLLOW THE PREMIUM SCHEDULES ESTABLISHED
BY THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING PURSUANT
TO SECTION 2619107 ARE required from the family of
each eligible person for children's health services. Enrollment
fees shall be deposited in the children's health plan cash fund,
which fund is hereby established. All moneys in the fund are
subject to annual appropriation by the general assembly for the
children's health plan. The administrator shall make an annual
redetermination of continued eligibility and identify people who
may become eligible for medical assistance. In the first year
of operation, the state contribution shall be thirteen dollars
per month or one hundred fiftysix dollars per year for enrollment
of each eligible person. Subsequent increased state contributions
shall be subject to approval by the general assembly. The administrator
shall negotiate rates for covered services, subject to the approval
of the board.
SECTION 16. 2617109
(1) and the introductory portion to 2617109 (3), Colorado
Revised Statutes, are amended to read:
2617109. Participation
by managed health care systems. (1) Managed
health care systems participating in the plan shall do so by contract
with the health sciences center and shall provide, directly or
by contract with other health care providers, covered services
to each eligible person. NO NEW CONTRACTS FOR THE CHILDREN'S
HEALTH PLAN SHALL BE EXECUTED WITH PROVIDERS AND NO NEW ENROLLEES
SHALL BE ACCEPTED INTO THE CHILDREN'S HEALTH PLAN ON OR AFTER
THE EFFECTIVE DATE OF THIS SUBSECTION (1) AS AMENDED. A participating
managed health care system may offer, without additional cost
to the patient or state, health care benefits or services not
included in the schedule of covered services under the plan.
A participating managed health care system shall not give preference
in enrollment to eligible persons who accept such additional health
care benefits or services. Managed health care systems participating
in the plan shall not discriminate against any potential or current
eligible person based upon health status, sex, race, ethnicity,
or religion. The administrator 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 persons, but nothing in
this article empowers the administrator to impose any sanctions
under any professional or facility licensing statute.
(3) Prior to negotiating with any managed
health care system, the administrator shall determine, on an actuarially
sound basis, the reasonable cost of providing the schedule of
basic
health care services, expressed in terms of upper and lower limits,
and recognizing variations in the costs of providing the services
through the various systems and in different areas of the state.
In negotiating with managed health care systems for participation
in the plan, the administrator shall adopt a uniform procedure
that includes at least all of the following:
SECTION 170 2617115,
Colorado Revised Statutes, is amended to read:
2617115. Repeal of article.
This article is repealed, effective July 1, 1998
1999.
SECTION 180 241119.5,
Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW
SUBSECTION to read:
241119.5. Department of
health care policy and financing creation.
(7) THE CHILDREN'S BASIC HEALTH PLAN POLICY BOARD
CREATED IN SECTION 2619104.6, C.R.S., AND ITS POWERS,
DUTIES, AND FUNCTIONS ARE TRANSFERRED BY A TYPE 1 TRANSFER
TO THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING.
SECTION 190 Federal funds.
The general assembly anticipates that, for the fiscal year beginning
July 1, 1997, the department of health care policy and financing
will receive the sum of one million three hundred fiftyseven
thousand five hundred two dollars ($1,357,502) in federal funds
for the implementation of this act. Although these funds are
not appropriated in this act, they are noted for the purpose of
indicating the assumptions used relative to these funds.
SECTION 200 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 Patricia K. Dicks
CHIEF CLERK OF THE HOUSE ASSISTANT SECRETARY OF
OF REPRESENTATIVES THE SENATE
APPROVED________________________________________
_________________________________________
Roy Romer
GOVERNOR OF THE STATE OF COLORADO