1999

SENATE BILL 99­179

BY SENATORS Lacy, Owen, and Tanner;

also REPRESENTATIVES Tool, Berry, and Saliman.

CONCERNING A SUPPLEMENTAL APPROPRIATION TO THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCE.

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

SECTION 1. Part V of section 2 of chapter 336, Session Laws of Colorado 1998, is amended to read:

Section 2. Appropriation.

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

4 (Governor lined through this provision. See L. 98, p. 2193.)

5 All 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. Each principal department of the state shall produce its rules and regulations in an electronic format that is suitable for public access through electronic means. Such rules and regulations in such format shall be submitted to the Office of Legislative Legal Services for publishing on the Internet. It is the intent of the General Assembly that this be done within existing resources.

8 (Governor lined through this provision. See L. 98, p. 2193.)

35 Department of Health Care Policy and Financing, Executive Director's Office ­­ The Department is requested to submit an accounting of all line items by actual expenditure. Actual expenditure is defined as final expenditure, including post­closing payments. The Department is requested to submit this information to the Joint Budget Committee by January 1, 1999.

36 Department of Health Care Policy and Financing, Medical Programs Administration, Contractual Utilization Review ­­ Contained within this appropriation is $49,373 ($12,343 General Fund and $37,030 federal funds) which is to be used for costs related to the expansion of the Model 200 Home and Community Based Services program. It is the intent of the General Assembly that this particular sum be restricted by the Department pending a finding by the Joint Budget Committee that the Department has provided the following information: (1) options and recommendations for the implementation of a premium buy­in or co­payment system for the Model 200 Home and Community Based Services program, including recommendations on specific income categories and medical expense thresholds; (2) an analysis of feasibility, time lines, cost estimates, and program cost changes associated with such a premium buy­in or co­payment system; and (3) the statutory changes necessary to require that private insurance cover these services. The Department is furthermore requested to work with the Department of Regulatory Agencies to determine if there is a way to coordinate the services for the provision of insurance offered by the Colorado Uninsurable Health Insurance Program (CUHIP) to the population served by the Model 200 Home and Community Based Services program. The Department is requested to report this information to the Joint Budget Committee by no later than June 1, 1998.

37 Department of Health Care Policy and Financing, Medical Programs Administration, Single Entry Point Deinstitutionalization Pilot ­­ The Department is requested to report on the results of the Single Entry Point Deinstitutionalization Pilot. The report should include the following information: (1) the number of clients deinstitutionalized; (2) the necessary acute and community expenditures related to the deinstitutionalization; (3) the level of need of the individuals deinstitutionalized; (4) recommendations for further deinstitutionalization projects, if any; (5) recommendations on any changes to the initial screening tools based on the success of the deinstitutionalization of clients meeting such screens; and (6) recommendations on changing the ways clients are placed into nursing facility services through the single entry points and alternative means. This report is requested to be provided to the Joint Budget Committee in the Department's budget submission for FY 1999­2000.

38 Department of Health Care Policy and Financing, Medical Services Premiums ­­ Contained within this appropriation is $2,442,298 ($1,189,184 General Fund and $1,253,114 federal funds) which is associated with the expansion of the Model 200 Home and Community Based Services program. It is the intent of the General Assembly that this particular sum be restricted by the Department pending a finding by the Joint Budget Committee that the Department has provided the following information: (1) options and recommendations for the implementation of a premium buy­in or co­payment system for the Model 200 Home and Community Based Services program, including recommendations on specific income categories and medical expense thresholds; (2) an analysis of feasibility, time lines, cost estimates, and program cost changes associated with such a premium buy­in or co­payment system; and (3) the statutory changes necessary to require that private insurance cover these services. The Department is furthermore requested to work with the Department of Regulatory Agencies to determine if there is a way to coordinate the services for the provision of insurance offered by the Colorado Uninsurable Health Insurance Program (CUHIP) to the population served by the Model 200 Home and Community Based Services program. The Department is requested to report this information to the Joint Budget Committee by no later than June 1, 1998.

39 Department of Health Care Policy and Financing, Medical Services Premiums ­­ It is the intent of the General Assembly that the Colorado Works program caseload, cost per client, and total expenditures be requested, tracked, and reported separately from other caseload categories.

40 Department of Health Care Policy and Financing, Medical Services Premiums ­­ The Department is requested to: (1) survey providers to determine how the base increase for Medical Services, Home and Community Based Services for the Elderly, Blind, and Disabled (HCBS­EBD) Personal Care and Homemaker Services was used; and (2) report on the associated decrease in staff turnover resulting from the increase in funding and on the utilization changes resulting. The Department is requested to report this information to the Joint Budget Committee no later than January 1, 1999.

41 Department of Health Care Policy and Financing, Medical Services Premiums ­­ It is the intent of the General Assembly to track the costs of providing services under Section 26­4­302 (1)(f), C.R.S. Accordingly, the Department is requested to (1) provide an estimate of the costs for FY 1997­98; (2) provide an estimate of the anticipated changes in the second year of implementation; and (3) provide estimates of savings in other Medicaid areas attributable to funding of this program. This report is requested to be submitted to the Joint Budget Committee by December 1, 1998.

42 Department of Health Care Policy and Financing, Medical Services Premiums ­­ 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.

43 Department of Health Care Policy and Financing, Medical Services Premiums ­­ 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.

44 Department of Health Care Policy and Financing, Medical Services Premiums ­­ The Department is requested to report on the growth in the home health program. The Department is requested to report on the specific reasons for the increase in client utilization of this service and its corresponding budget increase and to recommend program modifications, eligibility options and recommendations, and pricing adjustments. The Department is also requested to also quantify the impact in savings to hospitalization and nursing facility utilization based on the utilization of the home health program. The Department is also requested to report on any changes in the program which are occurring as a result of the actions taken by the federal government. This report is requested to be submitted to the Joint Budget Committee no later than October 15, 1998.

45 Department of Health Care Policy and Financing, Medical Services Premiums ­­ It is the intent of the General Assembly that the appropriation provided to increase the reimbursement rates for dental providers in the Medicaid program should in no way imply increased funding in future years. To this end, the Department is requested to prioritize and rejustify any change in the reimbursement rate for dental providers for FY 1999­2000. The Department is requested to research and report on its recommended reimbursement rate which will combine the goals of program efficiency with access to care. The Department is requested to seek input from the Colorado Dental Association in determining a reimbursement rate to increase utilization and service coverage statewide within these expressed goals. Specifically, the Department is to work with the Colorado Dental Association in reviewing the American Dental Association mean as appropriately applied to Colorado. The Department is also requested to report on the impact of the increase in funding for dental reimbursement. This report should include information on changes in the number of dental providers statewide, especially the change in previously undeserved areas, and changes in utilization by Medicaid eligibles statewide and in previously undeserved areas, with associated fiscal impact and related projections. A preliminary report is requested to the Joint Budget Committee by January 15, 1999, with a final report to be submitted by June 30, 1999.

46 Department of Health Care Policy and Financing, Medical Services Premiums ­­ The Department is requested to report its recommendations, if any, for changing the appropriation and program methodology for funding disproportionate share within the Medical Services premium categorical payments. This report is requested to be submitted to the Joint Budget Committee by September 1, 1998.

47 Department of Health Care Policy and Financing, Medical Services Premiums; Indigent Care Program, Specialty and Outstate Programs; and Disproportionate Share Payments to Hospitals ­­ It is the intent of the General Assembly that the federal cap on disproportionate share payments added in the 1997 Budget Reconciliation Act not be exceeded through state appropriations. The Department is requested to track all disproportionate share expenditures and estimates and report this information in its November 1, 1998 budget submission, as well as in any FY 1998­99 supplemental and FY 1999­2000 budget submission affecting these three areas, by state and federal fiscal year. The Department is also requested to report on its recommendations for prioritizing the available disproportionate share once the state estimate of federal matching funds reflected in the annual appropriations bills equals the federal cap.

48 Department of Health Care Policy and Financing, Medical Services Premiums; and Other Medical Services, Primary Care Physician Program Market Rate Reimbursement ­­ The Department is requested to provide a report on the Primary Care Physician Incentive Program. The Department should include in its report the following: delineation on the number of primary care physicians within Health Maintenance Organizations and in the Primary Care Physician program; delineation on the total allocation per primary care physician for Health Maintenance Organizations and the Primary Care Physician program estimated for FY 1997­98 by physician; and the estimated and derivation of the "lower­of" calculation for both FY 1997­98, FY 1998­99 and FY 1999­2000. Finally, the Department should include in its report its recommendations on programmatic or statutory changes, if any, to the Primary Care Physician program. This report is requested to be submitted to the Joint Budget Committee by September 1, 1998.

49 Department of Health Care Policy and Financing, Medical Services Premiums; and Department of Human Services Programs, Transfer to the Department of Human Services ­­ It is the intent of the General Assembly that the Department of Health Care Policy and Financing coordinate its efforts with the Department of Human Services to track the transferred Mental Health premium expenditures. The Department is requested to include in its November 1, 1998 budget submission a report on this coordination and a delineation of FY 1998­99 expenditures in this area.

50 Department of Health Care Policy and Financing, Medical Services Premiums; 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 Budget Committee by November 1, 1998, outlining the progress made in reducing the rate of low birth­weight 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 1997­98 program appropriation and recommendations for further programmatic and funding changes based on the findings.

51 Department of Health Care Policy and Financing, Other Medical Services, H.B. 97­1304 PAYMENT TO THE Children's Basic Health Plan TRUST FUND ­­ Of this sum, $1,343,999 represents the increased Medicaid managed care savings, $1,013,598 represents program consolidation, and $2,191,286 represents additional program savings as per Section 26­19­105(3) and (4), C.R.S. The $650,000 General Fund for program consolidation requested by the Department of Health Care Policy and Financing, and noted in their October 1, 1998 savings report, is reflected instead as cash funds exempt donations.

51a Department of Health Care Policy and Financing, Other Medical Services, H.B. 97­1304 Children's Basic Health Plan ­­ This appropriation assumes that ten percent for program administration is matched by Title XXI federal funds, assumes an average cost per child of $720 per year, and thus assumes an estimated annual caseload of 31,631 children. The Department is requested to report quarterly to the Joint Budget Committee, beginning October 1, 1998, on the program's projected administrative costs, and the federally reimbursable administration ratio as a percent of the total program, and on the program's estimated caseload.

SECTION 2. 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.

____________________________ ____________________________

Ray Powers Russell George

PRESIDENT OF SPEAKER OF THE HOUSE

THE SENATE OF REPRESENTATIVES

____________________________ ____________________________

Patricia K. Dicks Judith M. Rodrigue

SECRETARY OF CHIEF CLERK OF THE HOUSE

THE SENATE OF REPRESENTATIVES

APPROVED________________________________________

_________________________________________

Bill Owens

GOVERNOR OF THE STATE OF COLORADO