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HOUSE BILL 98-1342

BY REPRESENTATIVES Grampsas, Owen, and Romero;

also SENATORS Lacy, Blickensderfer, and Rizzuto.

Concerning a supplemental appropriation to the department of health care policy and financing.

Be it enacted by the General Assembly of the State of Colorado:

SECTION 1. Part V of section 2 of chapter 310, Session Laws of Colorado 1997, is amended to read:

Section 2. Appropriation.

PART V
DEPARTMENT OF HEALTH CARE POLICY AND FINANCING
(1) EXECUTIVE DIRECTOR'S OFFICE
Personal Services	1,232,123			487,376	(M)			15,000	a			729,747
	(20.1 FTE)
Health, Life, and Dental	258,637			127,848	(M)							130,789
Short-term Disability	11,752			5,186	(M)							6,566
Salary Survey and Anniversary Increases	96,795			47,910	(M)							48,885
Operating Expenses	148,824			104,409	(M)							44,415
Legal Services for 3,980 5,264 hours	191,035			95,518	(M)							95,517
	252,667			126,334	(M)							126,333
Third Party Recovery/ Legal Services for 1,852 2,201 hours	88,894							88,894	b
	105,646							105,646	b
Administrative Law Judge Services for 1,993 2,317 hours	169,166			84,583	(M)							84,583
	196,640			98,320	(M)							98,320
Computer Systems Costs	316,441			125,750	(M)			32,471	c			158,220
	339,085			137,072	(M)							169,542
Payment to Risk Management and Property Funds	27,456			13,728	(M)							13,728
Capitol Complex Leased Space	208,172			104,086	(M)							104,086
Transfer to the Department of Human Services for Related Administration	275,901			137,951	(M)							137,950
Tobacco Litigation Discovery Costs	600,000							600,000	d
		3,025,196
		3,753,698
a This amount shall be from the Cooperative Health Care Agreements Fund.
b This amount shall be from third party recoveries.
c This amount shall be from the Old Age Pension Fund.
d This amount shall be from litigants in State of Colorado ex rel. Norton v. R.J. Reynolds Tobacco Company et al., Case No. 97 CV3432 (Denver District Court).
(2) MEDICAL PROGRAMS
(A) Administration36, 37, 38, 39
Personal Services	6,061,313			2,842,301	(M)							3,219,012
	(111.9 FTE)
Operating Expenses	574,664			277,609	(M)							297,055
	626,664			303,609	(M)							323,055
Medicaid Management Information System Contract	11,018,631			2,884,712	(M)			146,867	a			7,987,052
Medicaid Management Information System Transition, Phase II40	10,910,782			1,723,800	(M)							9,186,982
Department of Public Health and Environment Facility Survey and Certification	3,269,314			908,485	(M)							2,360,829
Contractual Utilization Review	3,748,435			937,109	(M)							2,811,326
Early and Periodic Screening, Diagnosis, and Treatment Program	2,718,021			1,359,011	(M)							1,359,010
Nursing Home Audits	818,834			409,417	(M)							409,417
Hospital Audits	117,978			58,989	(M)							58,989
Nursing Home Preadmission and Resident Assessments	1,368,583			342,146	(M)							1,026,437
	1,139,744			284,936	(M)							854,808
Nurse Aide Certification	267,964			121,138	(M)					12,844	(T)b	133,982
Nursing Home Quality Assessments	28,873			7,218	(M)							21,655
Estate Recovery	500,000			250,000	(M)							250,000
Nursing Facility Appraisals	227,182			113,591	(M)							113,591
Single Entry Point Administration	60,000			30,000	(M)							30,000
Single Entry Point Audits	65,218			32,609	(M)							32,609
Phone Triage/Advice	315,000			78,750	(M)							236,250
Single Entry Point Deinstitutionalization Pilot	70,000			34,411	(M)							35,589
Medicaid Authorization Cards for Non-Medicaid Only Clients	369,898			184,949	(M)							184,949
	42,140,792
	42,333,851
a This amount shall be from the Old Age Pension Health and Medical Care Fund pursuant to Section 26-2-117, C.R.S.
b This amount shall be from the Department of Regulatory Agencies.
(B)Medical Services7, 8, 41, 42, 43, 44, 45, 46, 47, 48
Services for 34,036 33,950 Old Age Pensioners (OAP-A) at an average cost of $13,560.42 $13,329.50	461,542,383
	452,654,931
Services for 4,805 4,767 Old Age Pensioners (OAP-B) at an average cost of $8,631.24 $8,387.42	41,473,100
	40,018,251
Old Age Pension State Medical Program for 3,140 3,251 clients at an average cost of $3,081.79 $3,030.80	9,676,826
	9,853,133
Services for 54,874 51,412 Recipients of Aid to the Needy Disabled - Supplemental Security Income at an average cost of $5,944.09 $6,091.72	326,176,063
	313,293,183
Services for 158 148 Recipients of Aid to the Blind at an average cost of $3,403.26 $3,352.13	537,716
	496,477
Services for 35,792 31,378 Adult Clients Eligible Under the 7/16/96 Aid to Families with Dependent Children Program at an average cost of $2,622.63 $2,698.92	93,869,165
	84,832,835
Services for 116,030 107,333 Child Clients Eligible Under the 7/16/96 Aid to Families with Dependent Children Program at an average cost of $1,175.18 $1,224.08	136,356,535
	131,533,032
Services for 10,025 10,480 Foster Children at an average cost of $3,201.27 $3,229.05	32,092,745
	33,840,043
Services for 6,279 5,058 Baby Care Program Adults at an average cost of $5,599.56 $5,824.16	35,159,646
	29,442,355
Services for 10,255 6,228 Baby Care Program Children at an average cost of $1,327.03 $1,395.72	13,608,662
	8,754,399
Services for 4,706 4,613 Qualified Medicare Beneficiaries (QMBs) at an average cost of $1,433.66 $1,413.47	6,746,826
	6,520,429
Services for 5,579 5,549 Undocumented Aliens Non-citizens at an Average Cost of $2,540.87 $2,606.05	14,175,531
	14,573,807
H.B. 95-1081 Payments to the Department of Corrections	29,432
Enhanced Prenatal Care Services	1,350,000
	1,172,794,630			559,529,060	(M)			9,853,133	a			603,412,437
	1,125,842,307			537,307,436	(M)							578,681,738
a This amount shall be from the Old Age Pension Health and Medical Care Fund pursuant to Section 26-2-117, C.R.S.
(C) Indigent Care Program
Program Administration	262,116			262,116
				(3.0 FTE)
Denver Indigent Care	9,682,775			4,650,637	(M)							5,032,138
Specialty and Outstate Programs49	19,649,662			11,803,980	(M)							7,845,682
University Hospital	10,727,750			5,152,538	(M)							5,575,212
Disproportionate Share Payments to Providers Providers49a	110,886,355			54,335,892	(M)							56,550,463
	148,648,938									19,986,672	a	74,326,374
	151,208,658
	188,971,241
a This amount represents public funds certified as representing expenditures incurred by Denver Health and The University Hospital as eligible for federal financial participation under Medicaid Disproportionate Share Payments to Providers.
(D) Other Medical Services
Home Care Allowance for 6,216 5,780 Recipients at an average monthly cost of $228.647, 8	17,054,590			16,326,985						727,605	(L)
	15,858,346			15,334,072						524,274	(L)
Adult Foster Care for 359 263 Recipients at an average monthly cost of $198.257, 8 $205.977, 8	854,063			808,432						45,631	(L)
	650,010			617,510						32,500	(L)
Physician Incentive Pool	4,431,236			2,128,323	(M)							2,302,913
High Risk Pregnant Women Program	213,208			102,276	(M)							110,932
H.B. 92-1208 Immunizations	20,211			9,695	(M)							10,516
	91,175			43,736	(M)							47,439
Poison Control50	1,148,034			1,148,034
University of Colorado Family Medicine Residency Training Programs	1,989,749			954,483	(M)							1,035,266
Enhanced Prenatal Care Training and Technical Assistance	61,500			15,375	(M)							46,125
	25,772,591
	24,443,258
(E) Department of Human Services
Transfer to the Department of Human Services	304,032,830			145,326,233	(M)							158,706,597
	303,933,274			144,977,549	(M)							158,955,725
		1,695,949,501
		1,685,523,931
TOTALS PART V
(HEALTH CARE POLICY AND FINANCING)2, 3, 4		$1,698,974,697		$816,299,700				$10,136,365	a	$786,080	b	$871,752,552
		$1,689,277,629		$792,789,212				$10,753,117	a	$20,556,290	b	$865,179,010
a Of this amount, $10,000,000 is included as information for purposes of complying with the limitation on state fiscal year spending imposed by Article X, Section 20 of the State Constitution. As this amount is continuously appropriated by a constitutional provision, it is not subject to the limitation of General Fund appropriations as set forth in Section 24-75-201.1, C.R.S.
b Of this amount, $773,236 $556,774 contains an (L) notation, and $12,844 contains a (T) notation.

FOOTNOTES -- The following statements are referenced to the numbered footnotes throughout section 2.

2(Governor lined through this provision. See L. 97, p. 2057.)

3All Departments, Totals -- The General Assembly requests that copies of all reports requested in other footnotes contained in this act be delivered to the Joint Budget Committee and the majority and minority leadership in each house of the General Assembly.

4(Governor lined through this provision. See L. 97, p. 2058.)

7(Governor lined through this provision. See L. 97, p. 2058.)

8(Governor lined through this provision. See L. 97, p. 2058.)

36(Governor lined through this provision. See L. 97, p. 2059.)

37Department of Health Care Policy and Financing, Medical Programs, Administration -- The Department is requested to report to the Joint on the effectiveness of the primary care rate indexing initiative begun by the Department in FY 1994-95. The report is requested to include the change in the reimbursement for physicians, dentists, and emergency and county transportation for FY 1993-94 through FY 1997-98; the change in the number of Medicaid participating providers for the same time period relative to the need of the Medicaid eligible population; and recommendations for reimbursement methodologies in FY 1998-99. The Joint Budget Committee requests that this information be provided by no later than October 15, 1997.

38(Governor lined through this provision. See L. 97, p. 2059.)

39Department of Health Care Policy and Financing, Medical Programs, Administration; and Department of Law, Special Purpose, Medicaid Fraud Grant -- It is the intent of the General Assembly that all efforts be made to reduce the amount of fraudulent activity occurring within the state Medicaid program. To this end, the General Assembly requests that the departments cooperate to produce a report on Medicaid fraud, including: (1) estimates on the total amount of fraudulent activity; (2) information on which areas within Medicaid are particularly vulnerable to fraud, both fiscal and programmatic; (3) what new and existing efforts are being made by each department to remedy the problem of Medicaid fraud; and (4) recommendations on ways to prevent and catch fraudulent Medicaid claims, such as data systems or investigatory tools. The departments are requested to submit the report to the Joint Budget Committee by November 1, 1997.

40Department of Health Care Policy and Financing, Medical Programs, Administration, Medicaid Management Information System Transition, Phase II -- It is the intent of the General Assembly that the General Fund appropriation for the Medicaid Management Information System Transition, Phase II will be restricted by the State Controller until the Information Management Commission has certified, by letter, that the Department of Health Care Policy and Financing is "Year 2000" compatible, or, that this project specifically addresses a "Year 2000" need.

41Department of Health Care Policy and Financing, Medical Programs, Medical Services -- It is the intent of the General Assembly that expenditures for these services shall be recorded only against the Long Bill group total for Medical Services.

42Department of Health Care Policy and Financing, Medical Programs, Medical Services; Department of Human Services, Health and Rehabilitation Services, Office of Health and Rehabilitation, Mental Health Community Programs -- It is the intent of the General Assembly that the Department of Human Services and the Department of Health Care Policy and Financing cooperate to coordinate efforts to budget and forecast the Medicaid capitated payments for FY 1997-98 and FY 1998-99. The departments are requested to: (1) report on these coordination efforts; (2) provide recommendations for improving the link between the Medicaid Medical Services budget forecast, including caseload, case-mix, utilization, and anticipated cost increases, and the mental health system contracts; and (3) provide, by department, estimated savings and costs avoided for FY 1996-97, and estimated savings and cost avoidance for FY 1997-98 and FY 1998-99 attributable to the capitated mental health system. The departments are requested to report this information in their FY 1998-99 November 1 budget submission. The Department of Health Care Policy and Financing is requested to keep the Joint Budget Committee informed of any changes in its February, 1997 budgetary assumptions for mental health capitated payments transferred from the Medical Services Programs for FY 1997-98.

43Department of Health Care Policy and Financing, Medical Programs, Medical Services -- The General Assembly has determined that the average appropriated rates provide sufficient funds to pay reasonable and adequate compensation to efficient and economical providers. The Department should take actions to ensure that the average appropriated rates are not exceeded.

44Department of Health Care Policy and Financing, Medical Programs, Medical Services; and Department of Public Health and Environment, Family and Community Health Services Division, Family Planning, Purchase of Services -- The departments are requested to provide a report to the Joint BudgetCommittee by November 1, 1997, outlining the progress made in reducing the rate of low birth-weight babies as a result of the enhanced prenatal program appropriation. The report shall provide information on the number of participants, reasons for participation levels, and recommendations for changing participation levels given current program criteria. The report shall also delineate, by fiscal year, the total, General Fund, and federal fund savings achieved as a result of the FY 1996-97 program appropriation and recommendations for further programmatic and funding changes based on the findings.

45Department of Health Care Policy and Financing, Medical Programs, Medical Services -- The Department is requested to present a recommended methodology by which savings in Medicaid managed care, or in any other Medicaid initiative for which savings are estimated or anticipated, can be defined, tracked, and forecasted. This information is requested to be submitted to the Joint Budget Committee no later than November 1, 1997.

46Department of Health Care Policy and Financing, Medical Programs, Medical Services -- The Department is requested to report on the growth in the home and community based services for the elderly, blind, and disabled and the home health program. The Department is requested to report on the specific reasons for the increase and to recommend program modifications, eligibility options and recommendations, and pricing adjustments. The Department is also requested to report on any changes in the programs which are occurring as a result of the actions taken by the federal government, particularly in the area of home health. This report is requested to be submitted to the Joint Budget Committee no later than October 15, 1997.

47Department of Health Care Policy and Financing, Medical Programs, Medical Services -- The Department is requested to provide information on the caseload reduction in Medical Services attributable to state and federal welfare reform legislation, including, but not limited to supplemental security income children and legal immigrants no longer eligible for Medicaid services. The Department is also requested to provide estimates of any additional impact to the Indigent Care program associated with these changes. The Department is requested to provide this information in their FY 1998-99 budget submission.

48Department of Health Care Policy and Financing, Medical Programs, Medical Services -- The Department is requested to report on the total amount of primary care physician incentive payments contained within the FY 1997-98 payments made to health maintenance organizations by total expenditure, expenditure per health maintenance organization, and estimate the amount per physician. The Department is furthermore requested to report on the relative benefits provided to the state through this payment to health maintenance organizations.

49Department of Health Care Policy and Financing, Medical Programs, Indigent Care Program, Specialty and Outstate Programs -- The Department is requested to report on the FY 1996-97 and estimated FY 1997-98 growth in the Indigent Care program, specifically the Specialty and Outstate Indigent Care program. The Department is requested to report on the specific reasons for the increase and to recommend program and, if appropriate, reimbursement, modifications in order to limit the future growth in the appropriation. The Department is furthermore requested to report on: (1) the overall cost benefit, if any, achieved by the increase in clinic providers participating in the program; and (2) the impact of increases in capitated managed care on the Indigent Care program. This report is requested to be submitted to the Joint Budget Committee no later than November 1, 1997.

49aDepartment of Health Care Policy and Financing, Medical Programs, Indigent Care Program, Disproportionate Share Payments to Providers -- Itis the intent of the General Assembly that the federal funds reflected in this appropriation represent 100 percent of the federal funds which may be drawn down on behalf of the Medicaid disproportionate share payments to hospitals program. Any increase in the amount of federal funds, matched by public funds certified by the contributing entity as representing expenditures eligible for federal financial participation under Medicaid, shall require specific legislative approval with an accompanying appropriation showing the matching funds.

50Department of Health Care Policy and Financing, Medical Programs, Other Medical Services, Poison Control -- The Department is requested to report on the savings to the state as a result of the $1,148,034 General Fund appropriation for poison control services in FY 1996-97. The report is requested to include a breakdown of the savings by private payers, insurance, and Medicaid. This report is requested to be submitted to the Joint Budget Committee no later than February 1, 1998.

SECTION 2. Section 10 (2)(a), and (2)(c) of chapter 235, Session Laws of Colorado 1997, are amended to read:

Section 10. Appropriations in long bill to be adjusted. (2) 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, 1997, shall be adjusted as follows:

(a) The appropriation to medical programs, medical services is decreased by three million seventy-seven one hundred forty-one thousand eight nine hundred fifty-seven twenty-eight dollars ($3,077,857) ($3,141,928). Of said sum, one million three hundred four thirty-five thousand eight five hundred sixty ninety-five dollars ($1,304,860) ($1,335,595) shall be from the general fund, and one million seven eight hundred seventy-two six thousand nine three hundred ninety-seven thirty-three dollars ($1,772,997) ($1,806,333) shall be from matching federal funds.

(c) The general fund appropriation to medical programs, other medical services is increased by one hundred twenty-four thousand six hundred ninety-seven dollars ($124,697).

SECTION 3. Section 10 (2) of chapter 241, Session Laws of Colorado 1997, is amended to read:

Section 10. Appropriations in long bill to be adjusted. For the implementation of this act, appropriations made in the annual general appropriation act for the fiscal year beginning July 1, 1997, to the department of health care policy and financing, shall be adjusted as follows:

(2) The appropriation to medical programs, administration is increased by one million eighteen eight hundred eighty-six thousand one two hundred twenty-four thirty-six dollars ($1,018,124) ($886,236), and 3.0 FTE. Of said sum, three hundred eighty-five thousand eight hundred sixty dollars ($385,860) shall be from the general fund and subject to the "(M)" notation as defined in the general appropriation act and six five hundred thirty-two thousand two three hundred sixty-four seventy-six dollars ($632,264) ($500,376) shall be from matching federal funds. Said sum shall be for quality assurance and client grievance procedures pursuant to sections 26-4-115, 26-4-116 (1),26-4-120 (3), and 26-4-117 (1) (b), Colorado Revised Statutes.

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.

____________________________ ____________________________

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