C.R.S. § 25.5-1-101 Short title
25.5-1-101. Short title. This title shall be known and may be cited as the "State Health Care Policy and Financing Act".
Department of Health Care Policy and Financing
C.R.S. tit. 25.5, art. 1
in effectC.R.S. § 25.5-1-102 Legislative declaration
25.5-1-102. Legislative declaration. (1) The general assembly declares that state and local policymakers and health and human services administrators recognize that the management of and the delivery system for health and human services have become complex, fragmented, and costly and that the health and human services delivery system in this state should be restructured to adequately address the needs of Colorado citizens.
(2) The general assembly further finds and declares that a continuing budget crisis makes it unlikely that funding sources will keep pace with the increasing demands of health and human services.
(3) Therefore, the general assembly finds that it is appropriate to restructure principal departments responsible for overseeing the delivery of health and human services and to reform the state's health and human services administration and delivery system, using guiding principles and within the time frames set forth in article 1.7 of title 24, C.R.S., as said article existed prior to July 1, 1997. It is the general assembly's intent that the departments of public health and environment, health care policy and financing, and human services be operational, effective July 1, 1994.
C.R.S. § 25.5-1-103 Definitions
25.5-1-103. Definitions. As used in this title 25.5, unless the context otherwise requires:
(1) "County board" means the county or district board of human or social services; except that, in the city and county of Denver, "county board" means the department or agency with the responsibility for public assistance and welfare activities, and, in the city and county of Broomfield, "county board" means the city council or a board or commission with the responsibility for public assistance and welfare activities appointed by the city and county of Broomfield.
(2) "County department" means the county or district department of human or social services.
(3) "County director" means the director of the county or district department of human or social services.
(4) "Executive director" means the executive director of the department of health care policy and financing.
(5) "Medical assistance" means any program administered by the state department, including but not limited to the "Colorado Medical Assistance Act", as specified in articles 4, 5, and 6 of this title, the "Children's Basic Health Plan Act", article 8 of this title, the old age pension health and medical care program, and the supplemental old age pension health and medical care program; except that "medical assistance" for purposes of articles 4, 5, and 6 of this title shall have the meaning as defined in section 25.5-4-103 (13).
(5.5) "Medical home" means an appropriately qualified medical specialty, developmental, therapeutic, or mental health-care practice that verifiably ensures continuous, accessible, and comprehensive access to and coordination of community-based medical care, mental health care, oral health care, and related services for a child. A medical home may also be referred to as a health-care home. If a child's medical home is not a primary medical care provider, the child must have a primary medical care provider to ensure that a child's primary medical care needs are appropriately addressed. All medical homes shall ensure, at a minimum, the following:
(a) Health maintenance and preventive care;
(b) Anticipatory guidance and health education;
(c) Acute and chronic illness care;
(d) Coordination of medications, specialists, and therapies;
(e) Provider participation in hospital care; and
(f) Twenty-four-hour telephone care.
(6) "Member" means any person who has been determined eligible to receive benefits or services under this title 25.5.
(7) "State board" or "board" means the medical services board created pursuant to section 25.5-1-301.
(8) "State department" means the department of health care policy and financing.
(9) "State designated agency" means an agency designated to perform specified functions that would otherwise be performed by the county departments, including case management agencies, as defined in section 25.5-6-1702, and medical assistance sites.
C.R.S. § 25.5-1-104 Department of health care policy and financing created - executive director - powers, duties, and functions - report
25.5-1-104. Department of health care policy and financing created - executive director - powers, duties, and functions - report. (1) There is hereby created the department of health care policy and financing, the head of which shall be the executive director of the department of health care policy and financing, which office is hereby created. The executive director shall be appointed by the governor, with the consent of the senate, and shall serve at the pleasure of the governor. The reappointment of an executive director after an initial election of a governor shall be subject to the provisions of section 24-20-109, C.R.S. The executive director has those powers, duties, and functions prescribed for the heads of principal departments in the "Administrative Organization Act of 1968", article 1 of title 24, C.R.S., and any powers, duties, and functions set forth in this title.
(2) The department of health care policy and financing shall consist of an executive director of the department of health care policy and financing, the medical services board, and such divisions, sections, and other units as shall be established by the executive director pursuant to the provisions of subsection (3) of this section.
(3) The executive director may establish such divisions, sections, and other units within the state department as are necessary for the proper and efficient discharge of the powers, duties, and functions of the state department; except that such action by the executive director shall not conflict with the implementation requirements for the plan for restructuring the delivery of health and human services in this state, as set forth in article 1.7 of title 24, C.R.S.
(4) The department of health care policy and financing shall be responsible for the administration of the functions and programs as set forth in this title.
(5) (a) The executive director of the state department shall appoint an internal auditor who shall have the status of a division director and, as such, shall have the authority to appoint such personnel as may be necessary to carry out the duties of the internal auditor.
(b) The internal auditor appointed by the executive director pursuant to paragraph (a) of this subsection (5) shall:
(I) Conduct and supervise internal audits of the state department;
(II) Coordinate and facilitate external audits that are performed on the state department by state and federal entities;
(III) Conduct and supervise performance audits for the purpose of determining the efficiency and effectiveness of the state department's operation and administration of programs; and
(IV) Conduct such other audits and perform such other duties as may be specified by the executive director.
(6) (a) (I) The state department shall collaborate with the department of education, the department of public health and environment, and the department of human services to develop an interagency resource guide pursuant to section 22-2-410 to assist facilities to become licensed or authorized as approved facility schools and to recommend changes related to the interagency resource guide to the state department's statute, rule, or administrative procedures.
(II) The state department shall prominently post the interagency resource guide created pursuant to subsection (6)(a)(I) of this section on the state department's website.
(b) On or before November 1, 2023, the state department, after consulting with the facility school work group created in section 22-2-407.5, shall recommend a plan to provide guidance to approved facility schools on the eligibility standards required to request and receive medicaid reimbursement funding for therapeutic services to the maximum extent possible to reduce reliance on school district revenues for tuition payments required pursuant to section 22-20-109. The plan must include best practices from other states, recommendations on required federal or state authority changes, cost estimates, and cost-saving potentials.
C.R.S. § 25.5-1-105 Transfer of functions
25.5-1-105. Transfer of functions. (1) The state department shall, on and after July 1, 1994, execute, administer, perform, and enforce the rights, powers, duties, functions, and obligations vested prior to July 1, 1994, in the Colorado health data commission within the department of local affairs, the department of human services concerning the "Colorado Medical Assistance Act", and the university of Colorado health sciences center concerning health care for the medically indigent.
(2) All rules, regulations, and orders of the department of local affairs, the department of human services, the state board of human services, the department of regulatory agencies, and the university of Colorado health sciences center adopted prior to July 1, 1994, in connection with the powers, duties, and functions transferred to the state department continue to be effective until revised, amended, repealed, or nullified pursuant to law. On and after July 1, 1994, the state board or the executive director, whichever is appropriate, shall adopt rules necessary for the administration of the state department and the administration of the programs set forth in this title 25.5.
(3) No suit, action, or other judicial or administrative proceeding lawfully commenced prior to July 1, 1994, or which could have been commenced prior to such date, by or against the department of local affairs, the department of human services, the department of regulatory agencies, or the university of Colorado health sciences center, or any officer thereof in such officer's official capacity or in relation to the discharge of the official's duties, shall abate by reason of the transfer of duties and functions from said departments to the state department.
(4) The executive director, or a designee of the executive director, may accept, on behalf of and in the name of the state, gifts, donations, and grants for any purpose connected with the work and programs of the state department. Any property so given shall be held by the state treasurer, but the executive director, or the designee therefor, shall have the power to direct the disposition of any property so given for any purpose consistent with the terms and conditions under which such gift was created.
(5) The revisor of statutes is hereby authorized to change all references in the Colorado Revised Statutes to the department of local affairs, the department of human services, the department of regulatory agencies, and the university of Colorado health sciences center from said references to the state department, as appropriate and with respect to the powers, duties, and functions transferred to the state department. In connection with such authority, the revisor of statutes is hereby authorized to amend or delete provisions of the Colorado Revised Statutes so as to make the statutes consistent with the powers, duties, and functions transferred pursuant to this section.
(6) On and after July 1, 2003, the powers, duties, and functions relating to the old age pension health and medical care program, as specified in section 25.5-2-101, are transferred by a type 2 transfer to the department of health care policy and financing.
C.R.S. § 25.5-1-105.5 Chief medical officer - qualifications
25.5-1-105.5. Chief medical officer - qualifications. (1) The executive director shall appoint a chief medical officer who shall:
(a) Have a degree of doctor of medicine or doctor of osteopathy and be licensed to practice medicine in the state of Colorado;
(b) Have at least two years of postgraduate experience in primary care; and
(c) Have at least two years of experience in an administrative capacity in a health-care organization.
(2) The chief medical officer shall, with the assistance of advisory committees of the state department, provide medical judgment and advice regarding all medical issues involving programs administered by the state department.
(3) The chief medical officer shall receive a salary within the limits of moneys made available to the state department by appropriation of the general assembly or otherwise.
C.R.S. § 25.5-1-106 Restructure of health and human services - development of plan - participation of department required
25.5-1-106. Restructure of health and human services - development of plan - participation of department required. (Deleted by amendment)
C.R.S. § 25.5-1-107 Final agency action - administrative law judge - authority of executive director
25.5-1-107. Final agency action - administrative law judge - authority of executive director. (1) The executive director may appoint one or more individuals to serve as administrative law judges for the state department pursuant to section 24-4-105 and pursuant to part 10 of article 30 of title 24 subject to appropriations made to the department of personnel. Except as provided in subsection (2) of this section, hearings conducted by the administrative law judge are considered initial decisions of the state department, and the executive director or the executive director's designee shall review the initial decisions. If exceptions to the initial decision are filed pursuant to section 24-4-105 (14)(a)(I), the review must be conducted in accordance with section 24-4-105 (15). In the absence of any exception filed pursuant to section 24-4-105 (14)(a)(I), the executive director or the executive director's designee shall review the initial decision in accordance with a procedure adopted by the state board. The procedure must be consistent with federal mandates concerning the single state agency requirement. Review by the executive director or the executive director's designee in accordance with section 24-4-105 (15) or the procedure adopted by the state board pursuant to this section constitutes final agency action. The administrative law judge may conduct hearings on appeals from decisions of county departments of human or social services brought by members of and applicants for medical assistance and welfare that are required by law in order for the state to qualify for federal funds, and the administrative law judge may conduct other hearings for the state department. Notice of any hearing must be served at least ten days prior to the hearing.
(2) Hearings initiated by a licensed or certified provider of services shall be conducted by an administrative law judge for the state department and shall be considered final agency action and subject to judicial review in accordance with the provisions of section 24-4-106, C.R.S., for any party, including the state department, which shall be considered a person for such purposes.
C.R.S. § 25.5-1-108 Executive director - rules
25.5-1-108. Executive director - rules. (1) The executive director shall have authority to promulgate rules in connection with the policies and procedures governing the administration of the department including, but not limited to, rules concerning the following:
(a) Matters of internal administration of the department, including organization, staffing, records, reports, systems, and procedures;
(b) Fiscal and personnel administration for the department;
(c) Accounting and fiscal reporting policies and procedures for disbursement of federal funds, contingency funds, and distribution of available appropriations;
(d) Such other rules relating to those functions the executive director is required to carry out pursuant to the provisions of this title.
(2) Nothing in this section shall be construed to affect any specific statutory provision granting rule-making authority in relation to a specific program to the executive director.
C.R.S. § 25.5-1-109 Department of health care policy and financing cash fund
25.5-1-109. Department of health care policy and financing cash fund. All moneys collected by the state department as fees or otherwise shall be transmitted to the state treasurer, who shall credit the same to the department of health care policy and financing cash fund, which fund is hereby created in the state treasury. Moneys in the fund shall be subject to annual appropriation by the general assembly for the direct and indirect costs of the state department's duties as provided by law.
C.R.S. § 25.5-1-109.5 Clinical standards - development
25.5-1-109.5. Clinical standards - development. (1) The general assembly finds that:
(a) It is important to collect and analyze objective clinical standards to maximize the scarce dollars available for medical care; and
(b) The development of an ongoing, transparent measurement of health outcomes is essential to ensure quality health care for Coloradans.
(2) (a) The state department, following consultation with external clinical advisors, shall develop clinical standards and methods for collecting, analyzing, and disclosing information regarding clinical performance, including but not limited to immunization rates, medical home standards, clinical care guidelines, care coordination, case management, disease management, and coordination and integration of mental health services. The standards and methods shall be consistent with national guidelines and standards regarding the collection and analysis of health data, where feasible, and shall meet the federal reporting requirements established under Titles XIX and XXI of the federal "Social Security Act", 42 U.S.C. secs. 1396 and 1397.
(b) Repealed.
C.R.S. § 25.5-1-110 Study of children's access to health care coverage - acceptance of donations - repeal
25.5-1-110. Study of children's access to health care coverage - acceptance of donations - repeal. (Repealed)
C.R.S. § 25.5-1-111 Waiver applications - authorization
25.5-1-111. Waiver applications - authorization. (Deleted by amendment)
C.R.S. § 25.5-1-112 Drug-purchasing pool - report - repeal
25.5-1-112. Drug-purchasing pool - report - repeal. (Repealed)
C.R.S. § 25.5-1-113 Federal authorization - repeal
25.5-1-113. Federal authorization - repeal. (Deleted by amendment)
C.R.S. § 25.5-1-113.5 Children's access to health care - reports
25.5-1-113.5. Children's access to health care - reports. (Repealed)
C.R.S. § 25.5-1-114 Grants-in-aid - county supervision
25.5-1-114. Grants-in-aid - county supervision. (1) The state department shall consult with and coordinate with the counties before making any changes that affect county operations in the implementation of this section, when possible under state statutes and federal statutes and regulations.
(2) In administering any funds appropriated or made available to the state department for medical assistance administration, the state department has the power to:
(a) Require as a condition for receiving grants-in-aid that each county in this state shall bear the proportion of the total expense of furnishing medical assistance administration as is fixed by law relating to such assistance;
(b) Terminate any grants-in-aid to any county of this state if the laws and regulations providing such grants-in-aid and the minimum standards prescribed by rules of the state department thereunder are not complied with;
(c) Undertake forthwith the administration of any or all medical assistance within any county of this state which has had any or all of its grants-in-aid terminated pursuant to paragraph (b) of this subsection (2); but the county shall continue to meet the requirements of paragraph (a) of this subsection (2);
(d) Recover any moneys owed by a county to the state by reducing the amount of any payments due from the state in connection with the administration of medical assistance;
(e) Take any other action which may be necessary or desirable for carrying out the provisions of this title.
(3) The state department, under the supervision of the executive director, shall provide supervision of county departments for the effective administration of medical assistance as set out in the rules of the executive director and the rules of the state board pursuant to section 25.5-1-301; except that nothing in this subsection (3) shall be construed to allow counties to continue to receive an amount equal to the increased funding in the event the said funding is no longer available from the federal government.
C.R.S. § 25.5-1-114.5 Medicaid fraud detection - request for information
25.5-1-114.5. Medicaid fraud detection - request for information. (Repealed)
C.R.S. § 25.5-1-115 Locating violators - recoveries
25.5-1-115. Locating violators - recoveries. (1) The executive director of the state department, or district attorneys may request and shall receive from departments, boards, bureaus, or other agencies of the state or any of its political subdivisions, and the same are authorized to provide, such assistance and data as will enable the state department and county departments properly to carry out their powers and duties to locate and prosecute any person who has fraudulently obtained medical assistance under this title. Any records established pursuant to the provisions of this section shall be available only to the state department, the department of human services, the county departments, the attorney general, and the district attorneys, county attorneys, and courts having jurisdiction in fraud or recovery proceedings or actions.
(2) (a) All departments and agencies of the state and local governments shall cooperate in the location and prosecution of any person who has fraudulently obtained medical assistance under this title, and, on request of the county board, the county director, the state department, or the district attorney of any judicial district in this state, shall supply all information on hand relative to the location, employment, income, and property of such persons, notwithstanding any other provision of law making such information confidential, except the laws pertaining to confidentiality of any tax returns filed pursuant to law with the department of revenue. The department of revenue shall furnish at no cost to inquiring departments and agencies such information as may be necessary to effectuate the purposes of this article. The procedures whereby this information will be requested and provided shall be established by rule of the state department. The state department or county departments shall use such information only for the purposes of administering medical assistance under this title, and the district attorney shall use it only for the prosecution of persons who have fraudulently obtained medical assistance under this title, and shall not use the information, or disclose it, for any other purpose.
(b) (I) Whenever the state department, or a district attorney for the state department, or the state department on behalf of a county department, recovers any amount of fraudulently obtained medical assistance funds, the federal government shall be entitled to a share proportionate to the amount of federal funds paid unless a different amount is otherwise provided by federal law, the state shall be entitled to a share proportionate to the amount of state funds paid and such additional amounts of federal funds recovered as provided by federal law, and the county department shall be entitled to a share proportionate to the amount of county funds paid unless a different amount is provided pursuant to federal law or this section.
(II) (A) Whenever a county department, a county board, a district attorney, or a state department on behalf of a county department recovers any amount of fraudulently obtained public assistance funds in the form of assistance payments, it shall be deposited in the county social services fund, and the federal government is entitled to a share proportionate to the amount of federal funds paid, unless a different amount is provided for by federal law, the state is entitled to a share proportionate to one-half the amount of state funds paid, and the county is entitled to a share proportionate to the amount of county funds paid and, in addition, a share proportionate to one-half the amount of state funds paid.
rnment is entitled to a share proportionate to the amount of federal funds paid, unless a different amount is provided for by federal law, the state is entitled to a share proportionate to one-half the amount of state funds paid, and the county is entitled to a share proportionate to the amount of county funds paid and, in addition, a share proportionate to one-half the amount of state funds paid.
(B) Whenever a county department, a county board, a district attorney, or a state department on behalf of a county department recovers any amount of fraudulently obtained medical assistance, it shall be deposited in the county social services fund, and the federal government is entitled to a share proportionate to the amount of federal funds paid, unless a different amount is provided for by federal law, and the county is entitled to the remaining funds.
(3) Whenever a county department, a county board, a district attorney, or the state department on behalf of the county recovers any amount of medical assistance payments that were obtained through unintentional member error, the federal government is entitled to a share proportionate to the amount of federal funds paid, unless a different amount is provided for by federal law; the state is entitled to a share proportionate to seventy-five percent of the amount of state funds paid; and the county is entitled to a share proportionate to the amount of county funds paid, if any, and, in addition, a share proportionate to twenty-five percent of the amount of state funds paid.
(4) Actual costs and expenses incurred by the district attorney's office in carrying out the provisions of subsection (2) of this section shall be billed to counties or a county within the judicial district in the proportions specified in section 20-1-302, C.R.S. Each county shall make an annual accounting to the state department on all amounts recovered.
C.R.S. § 25.5-1-115.5 Medical assistance fraud - report
25.5-1-115.5. Medical assistance fraud - report. (1) Notwithstanding section 24-1-136 (11)(a)(I), on or before November 1, 2017, and each November 1 thereafter, the state department shall submit a written report to the joint budget committee; to the house of representatives judiciary committee and the house of representatives public and behavioral health and human services committee, or their successor committees; and to the senate judiciary committee and the senate health and human services committee, or their successor committees, concerning fraud in the medicaid program. The state department shall compile a single, comprehensive report that includes the information described in this subsection (1), as well as information that the attorney general provides to the state department pursuant to section 25.5-4-303.3. The state department shall report to the general assembly concerning the fraudulent receipt of medicaid benefits, including, at a minimum:
(a) Investigations of member fraud during the year;
(b) Termination of member medicaid benefits due to fraud;
(c) District attorney action, including, at a minimum, criminal complaints requested, cases dismissed, cases acquitted, convictions, and confessions of judgment;
(d) Recoveries, including fines and penalties, restitution ordered, and restitution collected;
(e) Trends in methods used to commit member fraud, excluding law enforcement-sensitive information; and
(f) An estimate of the total savings, total cost, and net cost-effectiveness of fraud detection and recovery efforts.
C.R.S. § 25.5-1-116 Records confidential - authorization to obtain records of assets - release of location information to law enforcement agencies - outstanding felony arrest warrants
25.5-1-116. Records confidential - authorization to obtain records of assets - release of location information to law enforcement agencies - outstanding felony arrest warrants. (1) The state department may establish reasonable rules to provide safeguards restricting the use or disclosure of information concerning applicants, members, and former and potential members of medical assistance for purposes directly connected with the administration of medical assistance and related state department activities, including the custody, use, and preservation of the state's and the county departments' records, papers, files, and communications. Whenever, as required by law, the names and addresses of applicants for, members of, or former and potential members of medical assistance are furnished to or held by another agency or department of government, the agency or department shall prevent the publication of lists of the names and addresses and prevent using the names and addresses for purposes not directly connected with the administration of medical assistance.
(2) (a) (I) Except as provided in subparagraphs (II) and (III) of this paragraph (a), it is unlawful for any person to solicit, disclose, or make use of or to authorize, knowingly permit, participate in, or acquiesce in the use of any lists or names of or any information concerning persons applying for or receiving public assistance and welfare directly or indirectly derived from the records, papers, files, or communications of the state or county departments or subdivisions or agencies thereof or acquired in the course of the performance of official duties. No financial institution or insurance company that provides the data, whether confidential or not, required by the state department, in accordance with the provisions of this subsection (2), shall be liable for the provision of the data to the state department nor for any use made thereof by the state department.
(II) The information described in subparagraph (I) of this paragraph (a) may be disclosed for purposes directly connected with the administration of medical assistance and in accordance with this paragraph (a) and paragraphs (b) and (c) of this subsection (2) and with the rules of the state department.
(III) (A) Notwithstanding any provision of state law to the contrary and to the extent allowable under federal law, at the request of the Colorado bureau of investigation, the state department shall provide the bureau with information concerning the location of any person whose name appears in the department's records who is the subject of an outstanding felony arrest warrant. Upon receipt of such information, it shall be the responsibility of the bureau to provide appropriate law enforcement agencies with location information obtained from the state department. Location information provided pursuant to this section shall be used solely for law enforcement purposes. The state department and the bureau shall determine and employ the most cost-effective method for obtaining and providing location information pursuant to this section. Neither the state department nor its employees or agents shall be liable in civil action for providing information in accordance with the provisions of this sub-subparagraph (A).
(B) As used in sub-subparagraph (A) of this subparagraph (III), "law enforcement agency" means any agency of the state or its political subdivisions that is responsible for enforcing the laws of this state. "Law enforcement agency" includes but is not limited to any police department, sheriff's department, district attorney's office, the office of the state attorney general, and the Colorado bureau of investigation.
subparagraph (A) of this subparagraph (III), "law enforcement agency" means any agency of the state or its political subdivisions that is responsible for enforcing the laws of this state. "Law enforcement agency" includes but is not limited to any police department, sheriff's department, district attorney's office, the office of the state attorney general, and the Colorado bureau of investigation.
(b) By signing an application or redetermination of eligibility form for medical assistance, an applicant authorizes the state department to obtain records pertaining to information provided in that application or redetermination of eligibility form from a financial institution, as defined in section 15-15-201 (4), C.R.S., or from any insurance company. The application or redetermination of eligibility form shall contain language clearly indicating that signing constitutes such an authorization.
(c) (I) In order to determine if applicants for or members of medical assistance have assets within eligibility limits, the state department may provide a list of information identifying the applicants or members to any financial institution, as defined in section 15-15-201 (4), or to any insurance company. The information provided may include identification numbers or social security numbers. The state department may require a financial institution or insurance company to provide a written statement disclosing any assets held on behalf of individuals adequately identified on the list provided. Before a termination notice is sent to the member, the county department or the medical assistance site, in verifying the accuracy of the information obtained as a result of the match, shall contact the member and inform the member of the apparent results of the computer match and give the member the opportunity to explain or correct any erroneous information secured by the match. The requirement to run a computerized match applies only to information that is entered in the financial institution's or insurance company's data processing system on the date the match is run and does not require any financial institution or insurance company to change its data or make new entries for the purpose of comparing identifying information. The state department shall pay for the cost of providing a computerized match.
(II) For the fiscal year beginning July 1, 1984, and thereafter, all funds expended by the state department to pay the cost of providing such computerized matches shall be subject to an annual appropriation by the general assembly.
(III) The state department may expend funds appropriated pursuant to subsection (2)(c)(II) of this section in an amount not to exceed the amount of annualized general fund savings that result from the termination of members from medical assistance specifically due to disclosure of assets pursuant to this subsection (2).
(d) An applicant must not be denied or any member must not be discontinued due to the disclosure of assets unless and until the county department or medical assistance site has assured that the assets taken together with other assets exceed the limit for eligibility of countable assets. Any information concerning assets found may be used to determine if the applicant's or member's eligibility for other medical assistance is affected.
(3) The applicant for or member of medical assistance, or the applicant's or member's representative, has an opportunity to examine all applications and pertinent records concerning the applicant or member that constitute a basis for denial, modification, or termination of medical assistance or to examine the records in case of a fair hearing.
(4) Any person who violates subsection (1) or (2) of this section commits a petty offense.
C.R.S. § 25.5-1-117 County departments - district departments
25.5-1-117. County departments - district departments. (1) Except as provided in subsection (2) of this section, there is established in each county of the state a county department of human or social services that consists of a county board of human or social services, a county director of human or social services, and any additional employees as may be necessary for the efficient performance of public assistance, as defined in section 26-2-103 (7), and medical assistance.
(2) Case management agencies established pursuant to part 17 of article 6 of this title 25.5 may act as state designated agencies and are authorized to carry out functions as specified in part 17 of article 6 of this title 25.5 that are otherwise performed by county departments of human or social services.
(3) With the approval of the state department of human services, two or more counties may jointly establish a district department of human or social services. All duties and responsibilities for county departments of human or social services set forth in this title 25.5 also apply to district departments of human or social services.
C.R.S. § 25.5-1-118 Duties of county departments
25.5-1-118. Duties of county departments. (1) The county departments or other state designated agencies, where applicable, shall serve as agents of the state department and shall be charged with the administration of medical assistance and related activities in the respective counties in accordance with the rules of the state department.
(2) The county departments or other state designated agencies, where applicable, shall report to the state department at such times and in such manner and form as the state department may from time to time direct.
(3) The county department or other state designated agencies, where applicable, in each county shall submit quarterly and annually to the board of county commissioners a budget containing an estimate and supporting data setting forth the amount of money needed to carry out the provisions of this title.
C.R.S. § 25.5-1-119 County staff
25.5-1-119. County staff. The county director, with the approval of the county board, shall appoint such staff as may be necessary as determined by the state department rules to administer medical assistance within the county. The staff shall be appointed and shall serve in accordance with a merit system for the selection, retention, and promotion of county department employees as described in section 26-1-120, C.R.S. The salaries of the staff members shall be fixed in accordance with the rules and salary schedules prescribed by the state department or the department of human services, whichever is appropriate; except that, once a county transfers its county employees to a successor merit system as provided in section 26-1-120, C.R.S., the salaries shall be fixed by the county commissioners.
C.R.S. § 25.5-1-120 Appropriations
25.5-1-120. Appropriations. (1) (a) For carrying out the duties and obligations of the state department and county departments under the provisions of this title and for matching such federal funds or meeting maintenance of effort requirements as may be available for public assistance and welfare activities in the state, including medical assistance administration and related activities, the general assembly, in accordance with the constitution and laws of the state of Colorado, shall make adequate appropriations for the payment of such costs, pursuant to the budget prepared by the executive director.
(b) If the federal law shall provide federal funds, in cash or in another form such as medical assistance, not otherwise provided for in this title, the state department is authorized to make such payments or offer such services in accordance with the requirements accompanying said federal funds within the limits of available state appropriations.
(c) When the executive director determines that adequate appropriations for the payment of the costs described in paragraph (a) of this subsection (1) have not been made and that an overexpenditure of an appropriation will occur based upon the state department's estimates, the state board may take actions consistent with state and federal law to bring the rate of expenditure into line with available funds. The general assembly declares that case load and utilization based on medical necessity are legitimate reasons for supplemental funding.
(2) The general assembly shall appropriate from the general fund to the state department moneys for the costs of administering medical assistance programs and the state's share of the costs of administering such functions by the county departments amounts sufficient for the proper and efficient performance of the duties imposed upon them by law, including a legal advisor appointed by the attorney general. The general assembly shall make two separate appropriations, one for the administrative costs of the state department and another for the administrative costs of the county departments. Any applicable matching federal funds shall be apportioned in accordance with the federal regulations accompanying such funds. Any unobligated and unexpended balances of appropriated state general funds remaining at the end of each fiscal year shall be credited to the state general fund.
(3) The expenses of training personnel for special skills relating to medical assistance, as such expenses shall be determined and approved by the state department, may be paid from state and federal funds available for such training purposes.
C.R.S. § 25.5-1-121 County expenditures - advancements - procedures
25.5-1-121. County expenditures - advancements - procedures. (1) For purposes of this article, under rules of the state department, administrative costs shall include: Salaries of the county director and employees of the county department staff engaged in the performance of medical assistance activities; the county's payments on behalf of such employees for old age and survivors' insurance or pursuant to a county officers' and employees' retirement plan and for any health insurance plan, if approved by the state department; the necessary travel expenses of the county board and the administrative staff of the county department in the performance of their duties; necessary telephone and other electronic means of communication; necessary equipment and supplies; necessary payments for postage and printing, including the printing and preparation of county warrants required for the administration of the county department; and such other administrative costs as may be approved by the state department; but advancements for office space, utilities, and fixtures may be made from state funds only if federal matching funds are available.
(2) Notwithstanding any other provision of this article, the county department may spend in excess of twenty percent of actual costs for the purpose of matching federal funds for the administration of the child support enforcement program or for the administrative costs of activities involving food stamp, public assistance, or medical assistance fraud investigations or prosecutions.
(3) (a) Notwithstanding any other provision of this article, the county department may receive and spend federal funds to which it is entitled based on the county's certification of public expenditures for administrative costs made by other entities within the county, which expenditures:
(I) Are from sources other than the county social services fund;
(II) Are in excess of the county department's portion, as required pursuant to section 25.5-1-114 (2)(a), of the administrative costs; and
(III) Are for an administrative activity that has been approved by the state department as an activity that is eligible for reimbursement under a federal program.
(b) Acceptance and expenditure of federal funds pursuant to paragraph (a) of this subsection (3) shall not affect the state's share of and contribution to the administrative costs. The county shall be solely responsible for certifying the nonfederal share that is in excess of the county's required portion of the administrative costs. The state department may retain up to five percent of any federal funds received by a county department pursuant to this subsection (3). In addition, the state, in accordance with the provisions of section 26-1-109 (4)(d), C.R.S., shall recover any federal funds received by the county through the certification of public expenditures that are subsequently determined to be ineligible for federal reimbursement.
C.R.S. § 25.5-1-122 County appropriation increases - limitations
25.5-1-122. County appropriation increases - limitations. (1) Beginning in calendar fiscal year 1994 and for each calendar fiscal year thereafter to and including calendar fiscal year 1997, the board of county commissioners in each county of this state shall annually appropriate funds for the county share of the administrative costs of medical assistance in the county in an amount equal to the actual county share for the previous fiscal year adjusted by an amount equal to the actual county share for the previous fiscal year multiplied by the percentage of change in property tax revenue.
(2) For the purposes of this section:
(a) "County share" means the actual amount of the county share for the previous fiscal year. "County share" shall not include:
(I) The amount expended by the county from the county contingency fund or the county tax base relief fund pursuant to section 26-1-126, C.R.S.;
(II) The amount expended by the county for general assistance pursuant to part 1 of article 17 of title 30, C.R.S.; and
(III) The amount expended by the county for programs or services provided by the county on its own, without requirements or funding from any other governmental agency.
(b) "Percentage of change in property tax revenue" means the difference between the total property tax levied for the previous fiscal year less the amount levied for debt service for the previous fiscal year and the total property tax levied for the year for which the percentage of change in tax revenue is being calculated less the amount levied for debt service for the year in which the percentage of change in tax revenue is being calculated divided by the total property tax levied for the previous fiscal year less the amount levied for debt service for the previous fiscal year.
(3) Notwithstanding the provisions of section 25.5-1-121, a county in the state shall not be required to contribute more than the amount set forth in subsection (1) of this section in any fiscal year. Nothing in this section shall be construed to limit the ability of a county to establish programs or services provided by the county on its own, without requirements or funding from any other governmental agency.
(4) (Deleted by amendment, L. 2008, p. 1812, § 3, effective June 2, 2008.)
(5) Any amounts remaining in the county social services fund created in section 26-1-123, C.R.S., at the end of any fiscal year shall remain in the county fund for expenditure as determined by the board of county commissioners for administrative costs of public assistance, medical assistance, and food stamps, and program costs of public assistance and food stamps.
(6) The limitation set forth in this section on the increase in the county share of the administrative costs of medical assistance will result in increased costs to the state. By making state funds available, the state is encouraging counties not to exercise any right a county may have pursuant to section 20 (9) of article X of the Colorado constitution to reduce or end its share of the costs of medical assistance administration for the county for three fiscal years following the fiscal year in which the state funds are received. If a county accepts funds from the state based on the limitation provided in this section for any fiscal year, the county agrees not to exercise any rights the county may have to reduce or end its share of the costs of medical assistance administration for the fiscal year in which the funds are accepted. Nothing in this subsection (6) or any agreement pursuant to this subsection (6) shall be construed to affect the existence or status of any rights accruing to the state or any county pursuant to section 20 (9) of article X of the Colorado constitution.
C.R.S. § 25.5-1-123 Medical homes for children - legislative declaration - duties of the department
25.5-1-123. Medical homes for children - legislative declaration - duties of the department. (1) The general assembly hereby finds and declares that:
(a) The best medical care for infants, children, and adolescents is provided through a medical home, as defined in section 25.5-1-103, and that is consistent with the joint principles of a patient-centered medical home. Those principles shall include a whole-person orientation, care that is coordinated and integrated across all elements of the complex health-care system and the patient's community, and care that provides for quality and safety of the patient where qualified health-care practitioners provide primary care and help manage and facilitate all aspects of medical care.
(b) Infants, children, and adolescents and their families work best with a health-care practitioner who knows the family and who develops a partnership of mutual responsibility and trust;
(c) Medical care provided through emergency departments, walk-in clinics, and other urgent-care facilities is often more costly and less effective than care given by a physician with prior knowledge of the child and his or her family; and
(d) The state department should strive to find a medical home for each child receiving services through the state medical assistance program, articles 4, 5, and 6 of this title, or the children's basic health plan, article 8 of this title.
(2) On or before July 1, 2008, the state department, in conjunction with the Colorado medical home initiative in the department of public health and environment, shall develop systems and standards to maximize the number of children enrolled in the state medical assistance program or the children's basic health plan who have a medical home. The systems and standards developed shall include, but need not be limited to, ways to ensure that a medical home shall offer family-centered, compassionate, culturally effective care and sensitive, respectful communication to a child and his or her family.
(3) Repealed.
C.R.S. § 25.5-1-124 Early intervention payment system - participation by state department - rules - definitions
25.5-1-124. Early intervention payment system - participation by state department - rules - definitions. (1) The state department shall participate in the development and implementation of the coordinated system of payment for early intervention services authorized pursuant to part 4 of article 3 of title 26.5 and part C of the federal "Individuals with Disabilities Education Act", 20 U.S.C. sec. 1400 et seq., as amended.
(2) The state department shall ensure that the early intervention services and payments for members of medical assistance pursuant to this title 25.5 are integrated into the coordinated early intervention payment system developed pursuant to part 4 of article 3 of title 26.5. To the extent necessary to achieve the coordinated payment system and coverage of those early intervention services pursuant to this title 25.5, the state department shall amend the state plan for medical assistance or seek the necessary federal authorization, promulgate rules, and modify the billing system for medical assistance to facilitate the coordinated payment system.
(3) The state department shall also make any modifications necessary to the "Children's Basic Health Plan Act", article 8 of this title 25.5, including promulgating rules, to ensure that the children's basic health plan is integrated into the coordinated early intervention payment system developed pursuant to part 4 of article 3 of title 26.5.
(4) Repealed.
(5) (a) As used in this section, unless the context otherwise requires, "early intervention services" means those services defined as early intervention services by the department of early childhood in accordance with section 26.5-3-402 (9) that are determined, through negotiation between the state department and the department of early childhood, to be medically necessary under medical assistance and cost-effective. After negotiating the scope of early intervention services to be covered under medical assistance, the state department and the department of early childhood shall submit to the joint budget committee of the general assembly, as part of each department's annual budget request, a proposal for the scope of coverage of early intervention services under medical assistance, including the anticipated costs of such coverage and whether the payment of such costs through medical assistance is cost-effective.
(b) "Early intervention services" shall not include the following:
(I) Nonemergency medical transportation;
(II) Respite care;
(III) Service coordination, as defined in 34 CFR 303.12 (d)(11); and
(IV) (A) Assistive technology.
(B) The exclusion of assistive technology shall not apply to durable medical equipment that is otherwise covered under the children's basic health plan, as defined in section 25.5-8-103 (2).
C.R.S. § 25.5-1-125 Centennial care choices - value benefit plans - request for information - request for proposals - report to general assembly - definitions - legislative declaration
25.5-1-125. Centennial care choices - value benefit plans - request for information - request for proposals - report to general assembly - definitions - legislative declaration. (Repealed)
C.R.S. § 25.5-1-126 Discounted prices for durable medical equipment and supplies
25.5-1-126. Discounted prices for durable medical equipment and supplies. (1) The state department shall work with one or more nonprofit organizations to develop a link of approved vendors who are willing to sell durable medical equipment and medical supplies at discounted prices to persons who have applied for, but are not yet receiving, benefits under the "Colorado Medical Assistance Act". The state department shall provide the exclusive criteria for a nonprofit organization to use to approve a vendor for placement on the approved vendor list.
(2) The state department shall maintain a link of approved vendors developed pursuant to this section and shall:
(a) Make the link available on the state department's website; and
(b) Provide copies of the list to county departments and to sites authorized to accept medical assistance applications pursuant to section 25.5-4-205 (1), through the survey given to applicants.
C.R.S. § 25.5-1-127 Third-party benefit denials information
25.5-1-127. Third-party benefit denials information. The state department shall provide information to members who receive benefits under this title 25.5 concerning the members' right to appeal a denial of benefits by a third party and shall post information on the state department's website concerning members' abilities to appeal a third party's denial of benefits, including but not limited to providing a link to information on the insurance commissioner's website regarding appeals.
C.R.S. § 25.5-1-128 Provider payments - compliance with state fiscal requirements - rules - definitions - repeal
25.5-1-128. Provider payments - compliance with state fiscal requirements - rules - definitions - repeal. (1) (a) Notwithstanding any provision of law to the contrary, when the state department has regulatory authority over a program and when the provider has already signed a state department-approved provider application to provide a service or to bill the state department or its authorized contractor for a service, the state department-approved provider application shall serve to fulfill the requirements of a commitment voucher and the fiscal requirements of section 24-30-202 (1), C.R.S.
(b) [Editor's note: This version of the introductory portion to subsection (1)(b) is effective until July 1, 2025.] The executive director may promulgate rules to exempt a provider who provides services through a program as described in paragraph (a) of this subsection (1) for any program the state department is authorized by law to administer, including but not limited to:
(b) [Editor's note: This version of the introductory portion to subsection (1)(b) is effective July 1, 2025.] The executive director may promulgate rules to exempt a provider who provides services through a program as described in subsection (1)(a) of this section for any program the state department is authorized by law to administer, including but not limited to:
(I) The "Colorado Medical Assistance Act", articles 4 to 6 of this title;
(II) The "Children's Basic Health Plan Act", article 8 of this title;
(III) (A) The "Colorado Indigent Care Program", part 1 of article 3 of this title;
(B) This subsection (1)(b)(III) is repealed, effective July 1, 2025.
(IV) The school health services program authorized by section 25.5-5-318;
(V) Programs that are funded through the primary care fund, created in section 24-22-117 (2)(b), C.R.S.; and
(VI) The state-funded old age pension health and medical care program pursuant to article 2 of this title.
(1.5) The state department shall maintain a list of enrolled school-based health centers and school-linked health-care services providers. The state department shall develop the list based on grant enrollment data pursuant to section 25-20.5-503 that is provided to the state department by the department of public health and environment. The state department shall establish a process for identifying claims for services provided in these settings.
(2) [Editor's note: This version of subsection (2) is effective until July 1, 2025.] As used in this section, unless the context otherwise requires, "provider" means a health-care provider, a mental health-care provider, a pharmacist, a home health agency, a general provider as defined in section 25.5-3-103 (3), a school district as defined in section 25.5-5-318 (1)(a), or any other entity that provides health care, health-care coordination, outreach, enrollment, or administrative support services to members through fee-for-service, a managed care entity, a behavioral health organization, a medical home, or any system of care that coordinates health care or services as defined and authorized through rules promulgated by the state board or by the executive director.
any other entity that provides health care, health-care coordination, outreach, enrollment, or administrative support services to members through fee-for-service, a managed care entity, a behavioral health organization, a medical home, or any system of care that coordinates health care or services as defined and authorized through rules promulgated by the state board or by the executive director.
(2) [Editor's note: This version of subsection (2) is effective July 1, 2025.] As used in this section, unless the context otherwise requires, "provider" means a health-care provider; a mental health-care provider; a pharmacist; a home health agency; a general hospital, birth center, or community clinic licensed or certified by the department of public health and environment pursuant to section 25-1.5-103 (1)(a)(I) or (1)(a)(II); a federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec 1395x (aa)(4); a rural health clinic, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2); a health maintenance organization issued a certificate of authority pursuant to section 10-16-402; a school district as defined in section 25.5-5-318 (1)(a); or any other entity that provides health care, health-care coordination, outreach, enrollment, or administrative support services to members through fee-for-service, a managed care entity, a behavioral health organization, a medical home, or any system of care that coordinates health care or services as defined and authorized through rules promulgated by the state board or by the executive director.
C.R.S. § 25.5-1-129 State department proposal - state option for health-care coverage - report to general assembly - waiver authorization - legislative declaration
25.5-1-129. State department proposal - state option for health-care coverage - report to general assembly - waiver authorization - legislative declaration. (1) (a) The general assembly finds that:
(I) Every Coloradan deserves access to high-quality, affordable health care to help support his or her well-being and economic security;
(II) To achieve these goals, Colorado has successfully implemented provisions of the federal "Patient Protection and Affordable Care Act" that have helped expand access and increase affordability to thousands of Coloradans, including expanding medicaid coverage to more low-income adults and creating the Colorado health benefit exchange;
(III) Despite this success, in several regions of the state, health insurance is not affordable due to high health-care costs and limited or no competition among insurance carriers as well as other marketplace factors, and Coloradans cannot afford the health insurance premiums and out-of-pocket expenses;
(IV) Specifically, Coloradans in fourteen counties have access to only a single health insurance carrier participating in the Colorado health benefit exchange, and the number of uninsured Coloradans in those counties is rising;
(V) Colorado has historically been a national leader in health-care innovation;
(VI) Uncertainty at the federal level requires Colorado to be proactive and explore and implement its own innovative solutions to provide greater access to affordable, high-quality health-care coverage for Colorado residents; and
(VII) A state option for health-care coverage that uses existing state health-care infrastructure may decrease costs for Coloradans, increase competition, and improve access to high-quality, affordable, and efficient health care.
(b) Therefore, the general assembly declares that tasking the state department and the division of insurance in the department of regulatory agencies, referred to in this section as "the division", with developing a proposal that considers the feasibility and cost of implementing a state option for health-care coverage that leverages existing state health-care infrastructure, increases competition, improves quality, and provides stable access to affordable health insurance will enable policymakers to consider and create an innovative state option for health insurance coverage to benefit Colorado.
(2) (a) On or before November 15, 2019, the state department and the division shall develop and submit a proposal to the joint budget committee; the public health care and human services and health and insurance committees of the house of representatives; and the health and human services committee of the senate, or any successor committees, for a state option for health-care coverage that leverages existing state infrastructure.
(b) In addition to submitting the proposal to the committees of the general assembly listed in subsection (2)(a) of this section, the state department and the division shall present a summary of the proposal at the annual joint meeting of the house and senate committees conducted during the legislative interim prior to the 2020 legislative session pursuant to section 2-7-203.
(3) The proposal must describe a state option for health-care coverage. The proposal must identify the most effective implementation of a state option based on affordability to consumers at different income levels, administrative and financial burden to the state, ease of implementation, and likelihood of success in meeting the objectives described in subsection (1) of this section.
(4) In developing the proposal, the state department and the division shall:
(a) Conduct actuarial research to identify the potential cost of premiums and cost sharing to pay claims in a plan that is, at a minimum, an essential health-benefit-compliant plan, as defined in section 10-16-102 (22);
ion, and likelihood of success in meeting the objectives described in subsection (1) of this section.
(4) In developing the proposal, the state department and the division shall:
(a) Conduct actuarial research to identify the potential cost of premiums and cost sharing to pay claims in a plan that is, at a minimum, an essential health-benefit-compliant plan, as defined in section 10-16-102 (22);
(b) Evaluate provider rates necessary to incentivize participation and encourage network adequacy and high-quality health-care delivery;
(c) Evaluate eligibility criteria for individuals and small businesses to participate;
(d) Determine the impact, if any, on the state budget;
(e) Determine the impact on the stability of the individual market, the small group market, and the Colorado health benefit exchange created in article 22 of title 10;
(f) Evaluate the impact on consumers eligible for financial assistance for plans purchased on the exchange;
(g) Determine whether a state option plan should be offered on or off the exchange;
(h) Determine whether the state option plan should be a fully at-risk, managed care, fee-for-service, or accountable care collaborative plan, or a combination thereof;
(i) Determine whether the state option should be offered through the state department, and identify the expected impact, if any, to the Colorado medical assistance program established in articles 4, 5, and 6 of this title 25.5;
(j) Identify the expected impact, if any, to the children's basic health plan established in article 8 of this title 25.5;
(k) Investigate funding options, including but not limited to state funds and federal funds secured through available waivers;
(l) Evaluate the feasibility, legality, and scope of any necessary federal waivers;
(m) Repealed.
(n) Create a statewide definition of affordability for consumers.
(5) In developing the proposal, the state department and the division shall consult with the Colorado health benefit exchange and shall engage in a stakeholder process that includes public and private health insurance experts, as well as consumers, consumer advocates, employers, providers, and carriers.
(6) The proposal submitted to the committees of the general assembly pursuant to this section must include detailed analysis of the proposed state option and the various methods for implementing the proposed state option, as well as any identified statutory or rule changes necessary to implement the proposed state option.
(7) (a) (I) After the proposal created pursuant to this section is submitted and presented to the committees of the general assembly, the state department and the division shall prepare and submit any federal waivers or state plan amendments necessary to fund and implement the state option for health-care coverage as described in the proposal created pursuant to subsection (2)(a) of this section.
(II) The state department's and the division's requests for federal authorization must seek to obtain the maximum amount of federal money available to the state and to persons participating in the state option for health-care coverage.
ments necessary to fund and implement the state option for health-care coverage as described in the proposal created pursuant to subsection (2)(a) of this section.
(II) The state department's and the division's requests for federal authorization must seek to obtain the maximum amount of federal money available to the state and to persons participating in the state option for health-care coverage.
(b) Notwithstanding the provisions of subsection (7)(a)(I) of this section to the contrary, the preparation and submission of federal waivers or amendments must be delayed if a member of the general assembly files a bill during the 2020 legislative session by the regular bill filing deadline of the house of representatives, as set forth in rule 23 of the joint rules of the senate and house of representatives, that substantially alters the federal authorization required pursuant to the proposal to implement the state option for health-care coverage, and such bill is not postponed indefinitely in the first committee of reference. The department's and the division's waiver preparation process shall resume after the bill is postponed indefinitely or, if passed by the general assembly, the requested waivers or state plan amendments must reflect the requirements in the passed legislation.
(c) Subject to the conditions described in subsection (7)(b) of this section, the state department and the division may promulgate rules, as necessary, for the preparation and submission of federal waivers or state plan amendments necessary to fund and implement the proposal.
C.R.S. § 25.5-1-130 Improving access to behavioral health services for individuals at risk of entering the criminal or juvenile justice system - duties of the state department
25.5-1-130. Improving access to behavioral health services for individuals at risk of entering the criminal or juvenile justice system - duties of the state department. (1) On or before March 1, 2020, the state department shall develop measurable outcomes to monitor efforts to prevent medicaid members from becoming involved in the criminal or juvenile justice system.
(2) On or before July 1, 2021, the state department shall work collaboratively with managed care entities to create incentives for behavioral health providers to accept medicaid members with severe behavioral health disorders. The incentives may include, but need not be limited to, higher reimbursement rates, quality payments to managed care entities for adequate networks, establishing performance measures and performance improvement plans related to network expansion, transportation solutions to incentivize medicaid members to attend health-care appointments, and incentivizing providers to conduct outreach to medicaid members to ensure that they are engaged in needed behavioral health services, including technical assistance with billing procedures. The state department may seek any federal authorization necessary to create the incentives described in this subsection (2).
C.R.S. § 25.5-1-131 Insurance ombudsman - consumer advocate - duties
25.5-1-131. Insurance ombudsman - consumer advocate - duties. (1) There is hereby created in the state department the office of the insurance ombudsman to act as the advocate for consumer interests in matters related to access to and the affordability of the standardized health benefit plan created pursuant to section 10-16-1304. The ombudsman shall:
(a) Interact with consumers regarding their access to, the affordability of, and coverage issues with the standardized plan;
(b) Evaluate data to assess the standardized plan's network and affordability; and
(c) Represent the interests of consumers in public hearings held pursuant to section 10-16-1306.
(2) In the performance of the ombudsman's duties, the ombudsman shall act independently of the state department. Any recommendations made or positions taken by the ombudsman do not reflect those of the state department.
C.R.S. § 25.5-1-132 Report of medicaid reimbursement rates paid to community mental health center providers and independent providers - definition
25.5-1-132. Report of medicaid reimbursement rates paid to community mental health center providers and independent providers - definition. (1) On or before August 15, 2022, the state department shall publish a behavioral health rates report of medicaid reimbursement rates for providers of community mental health centers, as defined in section 27-66-101 (2), and independent mental health and substance abuse treatment providers, as described in subsection (2) of this section. The state department shall contract with an independent auditor to prepare the behavioral health rates report, as described in this subsection (1). The state department shall prepare, in coordination with the behavioral health rates report, a set of recommendations on creating equitable payment and payment models that minimize inappropriate payment variation in comparable behavioral health services between the providers of community mental health centers and independent mental health and substance use treatment providers. The state department shall present the behavioral health rates report and recommendations to the house of representatives public and behavioral health and human services committee, or any successor committee.
(2) The report prepared pursuant to subsection (1) of this section must reflect data from state fiscal year 2020-21 and identify discrepancies, if any, and the reasons for such discrepancies in medicaid reimbursement rates paid to providers of a community mental health center and independent mental health and substance abuse treatment providers for comparable services. The report must include a determination of and recommendations on whether reimbursement rates paid to community mental health center providers and independent mental health and substance use treatment providers are adequate to meet or exceed network adequacy standards in every region of the state. The data must be aggregated to ensure individual community mental health centers and independent providers are not identifiable and must comply with any other state and federal privacy laws. On or before November 15, 2022, the state department shall present an action plan for implementation to the joint budget committee. The state department shall produce a progress report on the state department's progress made in implementing the action plan presented to the joint budget committee on November 15, 2022, on or before August 1, 2023, and annually thereafter through August 1, 2025, and provide an update during its "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" hearing pursuant to section 2-7-203 on the findings and additional recommendations. The state department must fully implement the action plan no later than December 31, 2025.
(3) As used in this section, unless the context otherwise requires, "independent mental health and substance abuse treatment providers" means any outpatient behavioral health provider enrolled in medicaid and contracted with a managed care entity, as defined in section 25.5-5-403 (4), that is not licensed or designated as a community mental health center.
C.R.S. § 25.5-1-133 Access to behavioral health services for individuals under twenty-one years of age - rules - report - repeal
25.5-1-133. Access to behavioral health services for individuals under twenty-one years of age - rules - report - repeal. (1) On or before July 1, 2024, the state department shall provide members under twenty-one years of age with access to limited services without requiring a diagnosis. The limited services must be provided as part of the statewide managed care system pursuant to part 4 of article 5 of this title 25.5 and the school health services detailed in section 25.5-5-318.
(2) The limited services must include:
(a) Family therapy;
(b) Group therapy;
(c) Individual therapy;
(d) Services related to prevention, promotion, education, or outreach;
(e) Evaluation, intake, case management, and treatment planning; and
(f) Any other service determined necessary by the state department based on feedback received from stakeholders.
(3) In providing the limited services pursuant to this section, the state department must notify patients, providers, the department of human services, county departments of human or social services, law enforcement agencies, schools, and any other entity that may be impacted that the limited services are available on and after July 1, 2024.
(4) In implementing this section, the state department shall engage with interested and impacted stakeholders to solicit feedback.
(5) (a) Notwithstanding section 24-1-136 (11)(a)(I), on or before November 1, 2025, and on or before November 1 each year thereafter, the state department shall report to the house of representatives public and behavioral health and human services committee and the senate health and human services committee, or their successor committees, regarding the utilization of the services described in subsection (2) of this section. The contents of the report must be determined through the stakeholder process described in subsection (4) of this section. At a minimum, the report must include data on the utilization of services, by code, and any differences in utilization within the school health services program authorized by section 25.5-5-318.
(b) This subsection (5) is repealed, effective July 1, 2031.
C.R.S. § 25.5-1-134 Prescription benefits - department and pharmacy benefit manager - contracts - audit - rules
25.5-1-134. Prescription benefits - department and pharmacy benefit manager - contracts - audit - rules. (1) For contracts between a pharmacy benefit manager and the state department or one of its affiliated managed care organizations offering a prescription benefit plan that is issued or renewed on or after January 1, 2025, the amount charged by the pharmacy benefit manager to the state department or managed care organization for a prescription drug dispensed to an enrollee in the program of medical assistance created pursuant to section 25.5-4-104 must be equal to or less than the amount paid by the pharmacy benefit manager to a medicaid pharmacy for the prescription drug dispensed to the enrollee.
(2) The state board shall promulgate rules to implement this section, including rules guiding an audit of managed care or fee-for-service claims, to ensure that there is no violation of subsection (1) of this section.
C.R.S. § 25.5-1-201 Programs to be administered by the department of health care policy and financing - repeal
25.5-1-201. Programs to be administered by the department of health care policy and financing - repeal. (1) The state department shall administer the following programs and perform the following functions:
(a) The "Colorado Medical Assistance Act", as specified in articles 4, 5, and 6 of this title;
(b) (I) The "Colorado Indigent Care Program", as specified in part 1 of article 3 of this title;
(II) This subsection (1)(b) is repealed, effective July 1, 2025.
(c) Effective July 1, 1996, school entry immunization, as specified in part 9 of article 4 of title 25, C.R.S. Commencing on and after the fiscal year beginning July 1, 1996, the state department is authorized to contract with the department of public health and environment for the purpose of enforcing the school entry immunization requirements.
(d) Repealed.
(e) The "Children's Basic Health Plan Act", as specified in article 8 of this title;
(f) The old age pension health and medical care program, as specified in section 25.5-2-101;
(f.5) The reproductive health-care program that provides reproductive health-care services, as specified in section 25.5-2-103;
(g) Programs, services, and supports for persons with intellectual and developmental disabilities, as specified in article 10 of this title 25.5; and
(h) Any program concerning the wholesale importation of prescription drugs pursuant to part 2 of article 2.5 of this title 25.5.
C.R.S. § 25.5-1-202 Advisory committee on covering all children in Colorado - reports - definitions - repeal
25.5-1-202. Advisory committee on covering all children in Colorado - reports - definitions - repeal. (Repealed)
C.R.S. § 25.5-1-203 Prescription drug information and technical assistance program - expansion
25.5-1-203. Prescription drug information and technical assistance program - expansion. The state department may expand the prescription drug information and technical assistance program created in section 25.5-5-507 to include persons receiving drug benefits pursuant to any program that is administered by the state department.
C.R.S. § 25.5-1-204 Advisory committee to oversee the all-payer health claims database - creation - members - duties - legislative declaration - rules - report
25.5-1-204. Advisory committee to oversee the all-payer health claims database - creation - members - duties - legislative declaration - rules - report. (1) The general assembly hereby finds and declares that an advisory committee for the all-payer health claims database would support the database in its established mission of facilitating the reporting of health-care and health quality data that results in transparent and public reporting of safety, quality, cost, and efficiency information; and analysis of health-care spending and utilization patterns for purposes that improve the population's health, improve the care experience, and control costs.
(2) (a) No later than August 1, 2013, the executive director shall appoint an advisory committee to oversee the Colorado all-payer health claims database. The advisory committee shall include the following members:
(I) A member of academia with experience in health-care data and cost efficiency research;
(II) A representative of:
(A) A statewide association of hospitals;
(B) An integrated multi-specialty organization;
(C) Physicians and surgeons;
(D) An organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity;
(E) A nonprofit organization that demonstrates experience working with employers to enhance value and affordability in health insurance;
(F) Dental insurers;
(G) Pharmacists or an affiliate society;
(H) Pharmacy benefit managers;
(I) A statewide association of ambulatory surgical centers;
(III) A representative, who is not a supplier or broker of health insurance, of:
(A) Small employers that purchase group health insurance for employees;
(B) Large employers that purchase health insurance for employees;
(C) Self-insured employers;
(IV) A representative from a comprehensive community behavioral health provider, as defined in section 27-50-101, who has experience in behavioral health data collection;
(V) Three representatives with a demonstrated record of advocating health-care issues on behalf of consumers;
(VI) Two representatives of health insurers, one who represents nonprofit insurers and one who represents for-profit insurers;
(VII) Two representatives of nonprofit organizations that facilitate health information exchange to improve health care for all Coloradans;
(VIII) The executive director or his or her designee, serving as an ex officio member;
(IX) The commissioner of insurance or his or her designee, serving as an ex officio member;
(X) A representative of the department of personnel, serving as an ex officio member;
(XI) The director of the office of information and technology or his or her designee, serving as an ex officio member; and
(XII) Two members of the general assembly, one appointed by the majority leader of the senate and one appointed by the majority leader of the house of representatives; except that, if the majority leaders are from the same political party, the minority leader of the house of representatives shall appoint the second member. The two members of the general assembly shall serve as ex officio members.
(XII) Two members of the general assembly, one appointed by the majority leader of the senate and one appointed by the majority leader of the house of representatives; except that, if the majority leaders are from the same political party, the minority leader of the house of representatives shall appoint the second member. The two members of the general assembly shall serve as ex officio members.
(b) The advisory committee shall make recommendations to the executive director and the Colorado all-payer health claims database administrator related to the Colorado all-payer health claims database. The recommendations include the following:
(I) Procedures for the collection, retention, use, and disclosure of data from the Colorado all-payer health claims database, including procedures and safeguards to protect the privacy, integrity, confidentiality, and availability of any data;
(II) Guidelines for charging for custom reports from the Colorado all-payer health claims database;
(III) Procedures to ensure compliance with the "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended, and implementing federal regulations;
(IV) Procedures to ensure compliance with other state and federal privacy laws; and
(V) Procedures for data confidentiality and data disposal if the Colorado all-payer health claims database ceases to exist.
(c) The members of the advisory committee appointed pursuant to subparagraph (XII) of paragraph (a) of this subsection (2) are entitled to receive compensation and reimbursement of expenses as provided in section 2-2-326, C.R.S.
(3) (a) The administrator shall prepare and file annual reports to the legislature by March 1 of each year. The annual report must contain:
(I) The uses of the data in the all-payer health claims database;
(II) Public studies produced by the administrator;
(III) The cost of administering the Colorado all-payer health claims database, the sources of the funding, and the total revenue taken in by the database;
(IV) The recipients of the data, the purposes for the data requests, and whether a fee was charged for the data;
(V) A fee schedule displaying the fees for providing custom data reports from the Colorado all-payer health claims database.
(b) The executive director shall require an evaluation of the Colorado all-payer health claims database initiative every five years beginning in 2018, to ensure that the database accomplishes the goals of this section. The report must contain metrics that document and demonstrate the achievements or challenges of the program goals.
(c) (I) By November 15, 2022, and by each November 15 thereafter, subject to available appropriations, the administrator shall provide a primary care spending report to the commissioner of insurance for use by the primary care payment reform collaborative established in section 10-16-150 regarding primary care spending:
(A) By carriers, as defined in sections 10-16-102 (8) and 24-50-603 (2);
(B) Under the "Colorado Medical Assistance Act", articles 4, 5, and 6 of this title 25.5; and
(C) Under the "Children's Basic Health Plan Act", article 8 of this title 25.5.
(II) The report prepared in accordance with this subsection (3)(c) must include:
(A) The percentage of the medical expenses allocated to primary care;
(B) The share of payments that are made through nationally recognized alternative payment models and the share of payments that are not paid on a fee-for-service or per-claim basis; and
(C) Data related to the aligned quality measure set determined by the division of insurance in accordance with section 10-16-157 (3).
nclude:
(A) The percentage of the medical expenses allocated to primary care;
(B) The share of payments that are made through nationally recognized alternative payment models and the share of payments that are not paid on a fee-for-service or per-claim basis; and
(C) Data related to the aligned quality measure set determined by the division of insurance in accordance with section 10-16-157 (3).
(4) (a) The administrator shall seek funding for the creation of the all-payer health claims database and develop a plan for the financial stability of the database. If sufficient funding is received through gifts, grants, and donations on or before January 1, 2012, as determined by the executive director, the administrator shall, in consultation with the advisory committee, create the Colorado all-payer claims database.
(b) The general assembly may annually appropriate general fund money to the state department to pay for expenses related to the all-payer health claims database.
(5) If sufficient funding is received, the executive director shall direct the administrator to create the database and the administrator shall:
(a) Determine the data to be collected from payers and the method of collection, including mandatory and voluntary reporting of health-care and health quality data;
(b) Seek to establish agreements for voluntary reporting of health-care claims data from health-care payers that are not subject to mandatory reporting requirements in order to ensure availability of the most comprehensive and systemwide data on health-care costs and quality;
(c) Seek to establish agreements or requests with the federal centers for medicare and medicaid services to obtain medicare health claims data;
(d) Determine the measures necessary to implement the reporting requirements in a manner that is cost-effective and reasonable for data sources and timely, relevant, and reliable for consumers, public and private purchasers, providers, and policymakers;
(e) Determine the reports and data to be made available to the public with recommendations from the advisory committee in order to accomplish the purposes of this section, including conducting studies and reporting the results of the studies;
(f) Collect, aggregate, distribute, and publicly report performance data on quality, health outcomes, health disparities, cost, utilization, and pricing in a manner accessible for consumers, public and private purchasers, providers, and policymakers;
(g) Protect patient privacy in compliance with state and federal medical privacy laws while preserving the ability to analyze data and share with providers and payers to ensure accuracy prior to the public release of information;
(h) Repealed.
(i) Provide leadership and coordination of public and private health-care quality and performance measurements to ensure efficiency, cost-effectiveness, transparency, and informed choice by consumers and public and private purchasers; and
(j) Subject to available appropriations and at the request of the commissioner of insurance, publish information to the public concerning dental loss ratio information collected by the division of insurance pursuant to section 10-16-165.
(6) The administrator, with input from the advisory committee:
(a) Shall incorporate and utilize publicly available data other than administrative claims data if necessary to measure and analyze a significant health-care quality, safety, or cost issue that cannot be adequately measured with administrative claims data alone;
(b) Shall require payer data sources to submit data necessary to implement the all-payer claims database;
(c) Shall determine the data elements to be collected, the reporting formats for data submitted, and the use and reporting of any data submitted. Data collection shall align with national, regional, and other uniform all-payer claims databases' standards where possible.
(d) May audit the accuracy of all data submitted;
sources to submit data necessary to implement the all-payer claims database;
(c) Shall determine the data elements to be collected, the reporting formats for data submitted, and the use and reporting of any data submitted. Data collection shall align with national, regional, and other uniform all-payer claims databases' standards where possible.
(d) May audit the accuracy of all data submitted;
(e) May contract with third parties to collect and process the health-care data collected pursuant to this section. The contract shall prohibit the collection of unencrypted social security numbers and the use of the data for any purpose other than those specifically authorized by the contract. The contract shall require the third party to transmit the data collected and processed under the contract to the administrator or other designated entity.
(f) May share data regionally or help develop a multistate effort if recommended by the advisory committee.
(7) The all-payer health claims database shall:
(a) Be available to the public when disclosed in a form and manner that ensures the privacy and security of personal health information as required by state and federal law, as a resource to insurers, consumers, employers, providers, purchasers of health care, and state agencies to allow for continuous review of health-care utilization, expenditures, and quality and safety performance in Colorado;
(b) Be available to state agencies and private entities in Colorado engaged in efforts to improve health care, subject to rules promulgated by the executive director;
(c) Be presented to allow for comparisons of geographic, demographic, and economic factors and institutional size;
(d) Present data in a consumer-friendly manner.
(8) The collection, storage, and release of health-care data and other information pursuant to this section is subject to the federal "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended.
(9) The executive director shall promulgate rules as necessary to implement this section, which rules shall include the assessment of a fine for a payer required to submit data that does not comply with this section. Any fines collected shall be deposited in the all-payer health claims database cash fund, which is hereby created in the state treasury. The moneys in the fund shall be appropriated to the department of health care policy and financing for the purpose of maintaining the all-payer health claims database. The moneys in the fund shall remain in the fund and not revert to the general fund or any other fund at the end of any fiscal year.
(10) Repealed.
(11) If at any time, there is not sufficient funding to finance the ongoing operations of the database, the database shall cease operating and the advisory committee and administrator shall no longer have the duty to carry out the functions required pursuant to this section. If the database ceases to operate, the data submitted shall be destroyed or returned to its original source.
C.R.S. § 25.5-1-204.5 All-payer health claims database scholarship grant program - creation - definitions
25.5-1-204.5. All-payer health claims database scholarship grant program - creation - definitions. (1) As used in this section, unless the context otherwise requires:
(a) "Advisory committee" means the advisory committee to oversee the all-payer health claims database created pursuant to section 25.5-1-204.
(b) "Governmental entity" means a state or local governmental entity, including a state-supported institution of higher education, but does not include the state department.
(c) "Program" means the all-payer health claims database scholarship grant program established pursuant to this section.
(2) There is created in the state department the all-payer health claims database scholarship grant program to defray the costs of nonprofit and governmental entities in accessing the all-payer health claims database to conduct research.
(3) The state department shall:
(a) In consultation with the advisory committee, develop a grant application under the program consistent with the rules of the executive director;
(b) Accept applications for scholarship grants from any nonprofit or governmental entity needing access to the all-payer health claims database to conduct research;
(c) After considering the recommendations of the advisory committee, determine which grant applications to approve and the amount of each grant; and
(d) Distribute approved scholarship grants to nonprofit or governmental entities.
(4) The executive director shall, following recommendations of the state department and the advisory committee, adopt rules pursuant to section 24-4-103 governing the program, including procedures, criteria, and standards for awarding scholarship grants.
(5) The advisory committee shall:
(a) Consult with the state department on the development of a grant application form; and
(b) Review applications for scholarship grants and recommend which scholarship grants to approve and the amount of each recommended grant.
C.R.S. § 25.5-1-204.7 All-payer health claims database - creation of tool for review of data included in the database - definitions
25.5-1-204.7. All-payer health claims database - creation of tool for review of data included in the database - definitions. (1) As used in this section, unless the context otherwise requires:
(a) "Administrator" means the administrator of the all-payer health claims database.
(b) "All-payer health claims database" or "database" means the all-payer health claims database created pursuant to section 25.5-1-204.
(c) "Code" means CPT code, HCPCS code, or other packaged services or industry standard procedure code that may include time units, base unit values, or modifiers.
(d) "CPT code" means the current procedural terminology code, or its successor code, as developed and copyrighted by the American Medical Association or its successor entity.
(e) "Healthcare common procedure coding system code" or "HCPCS code" means the code established by the federal centers for medicare and medicaid services' alpha-numeric editorial panel for identifying health-care services in a consistent and standardized manner.
(f) "Private health-care payer" means a carrier, as defined in section 10-16-102 (8), that reports claims received from an out-of-network provider pursuant to section 12-30-113 (4).
(g) "Tool" means the tool developed by the administrator pursuant to this section to enable users to review certain health claims reimbursement data in the database.
(2) (a) To facilitate the accurate determination of the reimbursement rates pursuant to sections 10-16-704 (3)(d) and (5.5)(b), 12-30-113 (4), and 25-3-122 (3) and to provide transparency in the process, subject to available appropriations, the administrator shall create and maintain a tool for implementation by January 1, 2023, that enables users to review certain health claims reimbursement data included in the all-payer health claims database. The tool must include 2018 health claims reimbursement data as the first year of data.
(b) To the extent practicable, the tool must, at a minimum:
(I) Include twenty-fifth, fiftieth, sixtieth, and seventy-fifth percentile of in-network reimbursement rates based on claims and the number of claims submitted for each code by payer type, for all codes with sufficient volume reported to the database, for three years of data; and
(II) Be viewable and searchable by:
(A) Year;
(B) County;
(C) Geographic rating area and statewide;
(D) Payer type, including medicaid, medicare, and private health-care payers;
(E) Setting, including inpatient and outpatient services; and
(F) Specialty.
(c) The administrator shall ensure that the viewing or reporting of health claims data through the tool complies with all state and federal data privacy laws and antitrust laws.
(3) Subject to available appropriations, the administrator shall update the tool annually and may update the tool more frequently as determined by the administrator.
C.R.S. § 25.5-1-205 Providing for the efficient provision of health care through state-supervised cooperative action - rules
25.5-1-205. Providing for the efficient provision of health care through state-supervised cooperative action - rules. (1) Cooperation among health-care payors, including both private sector entities and federal and state-administered health-care programs, has the potential to eliminate needless and costly complexity in the administration of the programs and to benefit patients, payors, and the government. Further, alignment of financial incentives among private and public entities may accelerate and reinforce improvements in health-care quality and patient outcomes.
(2) The executive director shall facilitate departmental oversight of collaboration among providers, medicaid members and advocates, and payers that is designed to improve health outcomes and patient satisfaction and support the financial sustainability of the medicaid program.
(3) The executive director may promulgate rules relating to the collaborative process set forth in this section.
C.R.S. § 25.5-1-206 School-based substance abuse prevention and intervention program - creation - reporting - legislative declaration - definitions
25.5-1-206. School-based substance abuse prevention and intervention program - creation - reporting - legislative declaration - definitions. (1) (a) The general assembly finds and declares that:
(I) The 2011 healthy kids Colorado survey indicates that the top three substances that high school students report they use are alcohol, marijuana, and prescription drugs;
(II) With the legalization of marijuana by citizen initiative in Colorado, there is an increased availability of marijuana in the community and, at the same time, a decreased perception of harm related to marijuana use;
(III) Evidence-based prevention and intervention programs and education awareness programs targeted to school children who are twelve to nineteen years of age are needed to:
(A) Increase the perceived risk of harm associated with marijuana and alcohol use and prescription drug misuse;
(B) Decrease the rates of youth marijuana and alcohol use and prescription drug misuse and delay the age of first-time use; and
(C) Decrease the number of drug- and alcohol-related violations, suspensions, and expulsions reported by schools.
(b) Therefore, the general assembly declares that it is appropriate to award grants to schools, community-based organizations, and health organizations to provide school-based prevention and intervention programs that use evidence-based strategies, practices, and approaches to reduce the risk of marijuana and alcohol use and prescription drug misuse by school-aged children. Successful school-based programs will lead to increased overall health, behavioral health, and educational outcomes for Colorado's youth.
(2) As used in this section, unless the context otherwise requires:
(a) "Entity" means a school, school district, board of cooperative services, a nonprofit or not-for-profit community-based organization, or a community-based behavioral health organization.
(b) "Grant program" means the school-based substance abuse prevention and intervention grant program created in subsection (3) of this section.
(3) (a) The school-based substance abuse prevention and intervention grant program is created within the state department. The purpose of the grant program is to award competitive grants to entities to provide school-based prevention and intervention programs for youth twelve to nineteen years of age primarily focused on reducing marijuana use, but including strategies and efforts to reduce alcohol use and prescription drug misuse.
(b) To be considered for a competitive grant, the entity must demonstrate in the grant proposal that:
(I) The grant will be used to implement evidence-based programs and strategies delivered in the school setting that are designed to improve overall health, behavioral health, and educational outcomes for youth who are twelve to nineteen years of age;
(II) The entity is delivering the program and strategies to at-risk youth, regardless of the youths' eligibility for Colorado's medical assistance program; and
(III) The evidence-based programs and strategies are designed to achieve the following outcomes:
(A) An increase in the perceived risk of harm associated with marijuana use, prescription drug misuse, and underage alcohol use among youth who are twelve to nineteen years of age;
(B) A decrease in the rates of youth marijuana use, alcohol use, and prescription drug misuse;
(C) A delay in the age of first use of marijuana, alcohol, or prescription drug misuse;
(D) A decrease in the rates of youth who have ever used marijuana or alcohol or misused prescription drugs in their lifetime; and
(E) A decrease in the number of drug- and alcohol-related violations on school property, suspensions, and expulsions reported by schools.
lcohol use, and prescription drug misuse;
(C) A delay in the age of first use of marijuana, alcohol, or prescription drug misuse;
(D) A decrease in the rates of youth who have ever used marijuana or alcohol or misused prescription drugs in their lifetime; and
(E) A decrease in the number of drug- and alcohol-related violations on school property, suspensions, and expulsions reported by schools.
(4) On or before September 1, 2014, the state department shall establish procedures and timelines for grant applications, criteria for determining grant amounts and grantee reporting requirements, and any other grant program policies. The state department may amend these policies at any time.
(5) Subject to available appropriations, the state department shall award grants for the 2014-15 academic year and for each academic year thereafter. There is no limit on the number of grants that the state department may award, and the same entity may receive more than one grant if the state department considers the needs of at-risk students in communities throughout the state for school-based substance abuse prevention and intervention programs.
(6) Repealed.
C.R.S. § 25.5-1-207 Rural provider access and affordability stimulus grant program - advisory committee - fund - reporting - rules - definitions - repeal
25.5-1-207. Rural provider access and affordability stimulus grant program - advisory committee - fund - reporting - rules - definitions - repeal. (1) Definitions - rules. As used in this section:
(a) "Advisory committee" means the rural provider access and affordability advisory committee created in subsection (3)(a) of this section.
(b) "Affiliate" has the meaning set forth in section 25.5-4-402.8 (1)(b).
(c) "Frontier provider" means a provider that is located in a county in the state with a population density of six or fewer residents per one square mile.
(d) "Fund" means the rural provider access and affordability fund created in subsection (6)(a) of this section.
(e) "Grant program" means the rural provider access and affordability stimulus grant program established in subsection (2) of this section.
(f) "Health-care access projects" means the projects described in subsection (2)(c)(II) of this section.
(g) "Health-care affordability projects" means the projects described in subsection (2)(c)(I) of this section.
(h) "Hospital" means a hospital licensed or certified pursuant to section 25-1.5-103 (1)(a) or an affiliate owned or controlled, as defined in section 25.5-4-402.8 (1)(c), by the hospital.
(i) "Qualified rural provider" means a rural hospital that has a lower net patient revenue or fund balance compared with other rural hospitals, as determined by the state board by rule.
(j) "Rural community" means:
(I) A county with a population of fewer than fifty thousand residents; or
(II) A municipality with a population of fewer than twenty-five thousand residents if the municipality is not contiguous to a municipality with a population of twenty-five thousand or more residents.
(k) "Rural provider" means a hospital that is located in a rural community.
(l) "Telemedicine" has the meaning set forth in section 12-240-104 (6).
(2) Grant program - permissible uses of grant money. (a) The rural provider access and affordability stimulus grant program is hereby created in the state department. The purpose of the grant program is to provide state assistance in the form of grants to qualified rural providers based on financial need or the ability to expand health-care access. The grant program is intended to improve health-care affordability and access in rural communities.
(b) In consultation with the advisory committee, the state department shall administer the grant program and shall award grants to qualified rural providers in accordance with this section. The grants are paid out of money in the fund.
(c) Subject to the guidelines adopted pursuant to subsection (4) of this section and the rules promulgated by the state board pursuant to subsection (5)(b) of this section, qualified rural providers may use the money received through the grant program for:
(I) Projects that modernize the information technology infrastructure of rural providers, including projects that:
(A) Create a shared analytics platform and care coordination platforms among rural providers; and
(B) Enable technologies, including telehealth and e-consult systems, that allow rural providers to communicate, share clinical information, and consult electronically to manage patient care; and
(II) Projects that expand access to health care in rural communities, including projects that:
(A) Extend hours for access to health care in rural communities, including access to primary care and behavioral health services;
(B) Invest in dual track emergency department management in rural communities;
(C) Expand access to telemedicine in rural communities, including remote monitoring support;
(D) Provide new or replacement hospital beds in rural communities;
(E) Expand access to remote patient monitoring systems in rural communities;
(F) Expand access in rural communities to long-term care and recovery care in skilled nursing facilities; and
gency department management in rural communities;
(C) Expand access to telemedicine in rural communities, including remote monitoring support;
(D) Provide new or replacement hospital beds in rural communities;
(E) Expand access to remote patient monitoring systems in rural communities;
(F) Expand access in rural communities to long-term care and recovery care in skilled nursing facilities; and
(G) Create or expand sites that provide access in rural communities to surgical care; chemotherapy centers; imaging and advanced imaging, including magnetic resonance imaging and computerized tomography scans; and behavioral health care.
(d) To be eligible to receive grant money that originates from the money the state received from the coronavirus state fiscal recovery fund for a capital expenditure, a grant recipient must submit to the state department a written justification as set forth in 31 CFR 35.6 (b)(4) for the capital expenditure; except that this requirement does not apply if the state department determines that the written justification is not required based on how the expenditures authorized under this section will be reported to the United States department of the treasury. For grant money that does not originate from the money the state received from the coronavirus state fiscal recovery fund, a written justification is not required, except as the state department determines necessary to comply with federal written justification requirements.
(3) Advisory committee. (a) The rural provider access and affordability advisory committee is hereby created in the state department.
(b) The advisory committee consists of the following voting members, appointed by the executive director:
(I) One member representing the state department;
(II) One member representing the department of public health and environment;
(III) One member representing the office of ehealth innovation in the lieutenant governor's office;
(IV) One member representing a nonprofit organization with expertise in health care in rural communities;
(V) Four members representing rural providers, including at least two frontier providers; and
(VI) One health-care consumer located in a rural community who is a member of the disabled community.
(c) The executive director shall make all appointments to the advisory committee no later than August 1, 2022. Advisory committee members serve for the duration of the advisory committee. The executive director shall fill any vacancy by appointment.
(d) The executive director shall convene the first meeting of the advisory committee no later than September 1, 2022. At the first meeting, the advisory committee shall select a chair and vice-chair from among its members. The advisory committee shall conduct at least two meetings each year and may agree to conduct meetings more frequently.
(e) The advisory committee shall advise and make formal recommendations to:
(I) The state department on:
(A) The administration of the grant program;
(B) The guidelines adopted pursuant to subsection (4) of this section; and
(C) The selection of grant recipients; and
(II) The state board on the rules promulgated pursuant to subsection (5) of this section.
(4) Guidelines. (a) On or before December 31, 2022, the state department, in consultation with the advisory committee, shall adopt guidelines for the grant program that include:
(I) Procedures and timelines by which a qualified rural provider may apply for a grant;
(II) Criteria for determining grant eligibility and grant amounts; and
(III) Reporting requirements for grant recipients in accordance with subsection (8)(b) of this section and the rules promulgated by the state board pursuant to subsection (5)(c) of this section.
delines for the grant program that include:
(I) Procedures and timelines by which a qualified rural provider may apply for a grant;
(II) Criteria for determining grant eligibility and grant amounts; and
(III) Reporting requirements for grant recipients in accordance with subsection (8)(b) of this section and the rules promulgated by the state board pursuant to subsection (5)(c) of this section.
(b) The state department shall post the guidelines on the state department's website.
(5) Rules. On or before December 31, 2022, the state board, in consultation with the state department, shall promulgate rules as necessary for the administration of this section that include:
(a) A methodology to determine which rural providers are considered qualified rural providers;
(b) Permissible uses of grant money; and
(c) Reporting requirements for grant recipients.
(6) Fund. (a) The rural provider access and affordability fund is hereby created in the state treasury. The fund consists of:
(I) Money transferred to the fund pursuant to subsection (7) of this section;
(II) Money appropriated or transferred to the fund by the general assembly; and
(III) Any gifts, grants, or donations from any public or private sources, including governmental entities.
(b) The state department is authorized to seek, accept, and expend gifts, grants, or donations from public or private sources for the purposes of the grant program. The state department shall transmit all public or private money received through gifts, grants, and donations to the state treasurer, who shall credit the same to the fund.
(c) Except as otherwise required by this subsection (6)(c), all money not expended or encumbered, and all interest earned on the investment or deposit of money in the fund, must remain in the fund and shall not revert to the general fund or any other fund at the end of any fiscal year. The money in the fund is continuously appropriated to the state department for the purposes of this section. Any money in the fund not expended or encumbered by December 31, 2024, reverts to the general fund.
(7) Transfer. No later than July 1, 2022, the state treasurer shall transfer ten million dollars from the economic recovery and relief cash fund created in section 24-75-228 (2)(a) to the fund. The state department shall use:
(a) Four million eight hundred thousand dollars for awarding grants for health-care affordability projects;
(b) Four million eight hundred thousand dollars for awarding grants for health-care access projects; and
(c) Up to four hundred thousand dollars for the costs of administering the grant program.
(8) Reporting. (a) In its presentation to the joint committees of reference pursuant to section 2-7-203, the state department shall report on the progress of the grant program, including a report on the amount of grant money awarded to each grant recipient and a description of each grant recipient's use of the grant money.
(b) The state department and any person that receives money from the state department, including each grant recipient, shall comply with the compliance, reporting, record-keeping, and program evaluation requirements established by the office of state planning and budgeting and the state controller in accordance with section 24-75-226 (5).
(9) Repeal. This section is repealed, effective July 1, 2025.
C.R.S. § 25.5-1-301 Medical services board - creation
25.5-1-301. Medical services board - creation. (1) (a) There is created in the state department the medical services board, referred to in this part 3 as the "board". The board consists of members appointed by the governor with the consent of the senate as follows:
(I) One member from each congressional district in the state; and
(II) Three members from the state at large.
(b) The governor shall appoint persons to the board who have knowledge of medical assistance programs, and one or more of the appointments may include a person or persons who have received services through programs administered by the department within two years of the date of appointment.
(c) No more than a minimum majority of the members of the board may be affiliated with the same political party.
(d) In making appointments to the board, the governor shall include:
(I) One member from the private sector who has experience with the delivery of health care;
(II) One member who has experience or expertise in caring for medically underserved children; and
(III) Representation by at least one member who is a person with a disability, as defined in section 24-34-301, a family member of a person with a disability, or a member of an advocacy group for persons with disabilities, provided that the other requirements of this subsection (1) are met.
(2) Each member serves at the pleasure of the governor for a term of four years; except that the terms shall be staggered so that no more than a minimum majority of members' terms expire in the same year.
(3) Members shall receive no compensation but shall be reimbursed for reasonable and necessary actual expenses incurred in the performance of their official duties as members of the board.
(4) Vacancies on the board shall be filled by appointment of the governor for the remainder of any unexpired term.
(5) The board is a type 1 entity, as defined in section 24-1-105.
C.R.S. § 25.5-1-302 Medical services board - organization
25.5-1-302. Medical services board - organization. (1) The board shall elect from its members a president, a vice-president, and such other board officers as it shall determine. All board officers shall hold their offices at the pleasure of the board.
(2) Regular meetings of the board shall be held not less than once every three months at such times as may be fixed by resolution of the board. All meetings of the board, in every suit and proceeding, shall be considered to have been duly called and regularly held and all orders and proceedings of the board to have been authorized, unless the contrary is proven.
(3) The board shall adopt, and at any time may amend, bylaws in relation to its meetings and the transaction of its business. A majority shall constitute a quorum of the board. The vote of a majority of a quorum of the board shall constitute the action of the board. The board shall act only by resolution adopted at a duly called meeting of the board, and no individual of the board shall exercise any individual administrative authority with respect to the department.
C.R.S. § 25.5-1-303 Powers and duties of the board - scope of authority - rules - repeal
25.5-1-303. Powers and duties of the board - scope of authority - rules - repeal. (1) The board shall have the authority set forth in subsection (3) of this section over the following programs administered by the state department:
(a) The "Colorado Medical Assistance Act", as specified in articles 4, 5, and 6 of this title;
(b) (I) The "Colorado indigent care program", as specified in part 1 of article 3 of this title;
(II) This subsection (1)(b) is repealed, effective July 1, 2025.
(c) Repealed.
(d) The "Children's Basic Health Plan Act", as specified in article 8 of this title;
(e) The old age pension health and medical care program, as specified in section 25.5-2-101;
(f) Programs, services, and supports for persons with intellectual and developmental disabilities, as specified in article 10 of this title.
(2) Nothing in this section shall be construed to affect any specific statutory provision granting rule-making authority to the board in relation to a specific program.
(3) The board shall adopt rules in connection with the programs set forth in subsection (1) of this section governing the following:
(a) The implementation of legislative and departmental policies and procedures for such programs; except that no rules shall be promulgated for any policy or procedure which governs the administration of the state department as specified in section 25.5-1-108 (1);
(b) The establishment of eligibility requirements for members receiving services from the state department;
(c) The establishment of the type of benefits that are available to an applicant if eligibility requirements are met, subject to the authorization, requirements, and availability of the benefits;
(d) The requirements, obligations, and rights of members and applicants;
(e) The establishment of a procedure to resolve disputes that may arise between members and the state department or members and providers;
(f) The requirements, obligations, and rights of providers, including policies and procedures related to provider payments that may affect member benefits;
(g) The establishment of a procedure to resolve disputes that may arise between providers and between the state department and providers.
(4) At the request of the executive director, the board shall advise the executive director as to any proposed policies or rules governing programs administered by the state department that are not set forth in subsection (1) of this section.
(5) The board shall have no authority over the revenue of the state department.
(6) All rules and orders of the department of human services in connection with the old age pension health and medical care program shall continue to be effective until revised, amended, repealed, or nullified pursuant to law.
(7) The rules issued by the state board shall be binding upon the county departments. At any public hearing relating to a proposed rule-making, interested persons shall have the right to present their data, views, or arguments orally. Proposed rules of the state board shall be subject to the provisions of section 24-4-103, C.R.S.
(8) To the extent that rules are promulgated by the state board of human services for programs or providers that receive either medicaid only or both medicaid and nonmedicaid funding, the rules shall be developed in cooperation with the state department and shall not conflict with state statutes or federal statutes or regulations.
(9) The rules and orders of the department of human services and the state board of human services in connection with the programs, services, and supports specified in paragraph (f) of subsection (1) of this section shall continue to be effective until revised, amended, repealed, or nullified pursuant to law.
C.R.S. § 25.5-1-304 Repeal of part
25.5-1-304. Repeal of part. (Deleted by amendment)
C.R.S. § 25.5-1-601 Legislative declaration
25.5-1-601. Legislative declaration. (1) The general assembly hereby finds and declares that:
(a) Physicians engaged in family medicine are in critically short supply in this state;
(b) Because of the distribution of such physicians, many rural and urban areas of the state are underserved;
(c) A significant portion of the state population is medically underserved because of indigency;
(d) Family physicians provide health care to all segments of the population;
(e) The provision of more competent family physicians is a public purpose of great importance; and
(f) The creation of the commission on family medicine is a desirable, necessary, and cost-effective means of addressing the needs described in this subsection (1).
C.R.S. § 25.5-1-602 Commission created - composition - terms of office
25.5-1-602. Commission created - composition - terms of office. (1) There is created, in the department of health care policy and financing, the commission on family medicine, referred to in this part 6 as the "commission". The commission consists of the following members:
(a) The deans of accredited allopathic and osteopathic schools of medicine in the state or their designated representatives;
(b) The director of all family medicine programs in the state accredited by the accreditation council on graduate medical education of the American medical association or the American osteopathic association;
(c) A representative of the Colorado academy of family physicians; and
(d) A health-care consumer to be appointed by the governor from each congressional district in the state. No more than a minimum majority of the members of the commission appointed by the governor pursuant to this subsection (1)(d) may be affiliated with the same political party. A vacancy on the commission occurs whenever any health-care consumer member moves out of the congressional district from which the member was appointed. A health-care consumer member who moves out of the congressional district shall promptly notify the governor of the date of the move, but notice is not necessary for the vacancy to occur. The governor shall fill the vacancy in accordance with subsection (2) of this section.
(2) The members appointed under subsection (1)(d) of this section serve three-year terms. All members serve at the pleasure of the governor. The governor shall fill any vacancy by appointment for the remainder of the unexpired term.
(3) The commission shall elect a chairperson and a vice-chairperson from among its members. Members of the commission serve without compensation, but members described in subsections (1)(b), (1)(c), and (1)(d) of this section are entitled to their actual and necessary expenses incurred in the performance of their duties. The commission shall meet on call of the chairperson, but not less than once every three months. A majority of the members of the commission constitutes a quorum for the transaction of business.
C.R.S. § 25.5-1-603 Duties of commission - reporting
25.5-1-603. Duties of commission - reporting. (1) The commission shall:
(a) Assure that family medicine residency program standards are equal to or more stringent than the standards established by the accreditation council on graduate medical education of the American medical association or the American osteopathic association for residency training in family medicine;
(b) In cooperation with the dean of the school of medicine, approve and recommend allocation of any funds which are identified and appropriated in the general appropriation bill as a line item for any community family medicine residency training program;
(c) Monitor the state's family medicine residency programs and recommend from time to time that the general assembly appropriate funds for said programs;
(d) Locate specific areas of the state which are underserved by family physicians and determine the priority of need among such areas;
(e) Offer to the general assembly alternative ideas on providing medical care to the medically indigent in the state; and
(f) (I) Support the development and maintenance of family medicine residency programs in rural and other underserved areas of the state for purposes of cultivating family medicine practitioners who are likely to continue practicing in rural and underserved areas of the state at the conclusion of their residency programs.
(II) On or before each November 1, the commission shall report to the office of state planning and budgeting and to the department of health care policy and financing concerning rural family medicine residency programs in the state and the role of the commission with respect to supporting the development and maintenance of those programs. In addition, notwithstanding section 24-1-136 (11), the commission shall present the report to the joint budget committee as part of its annual presentation to that committee.
C.R.S. § 25.5-1-701 Definitions
25.5-1-701. Definitions. As used in this part 7, unless the context otherwise requires:
(1) "Community" means the community that a hospital has defined as the community that it serves pursuant to 26 CFR 1.501(r)-3 (b)(3).
(2) "Community benefit implementation plan" means a plan that satisfies the requirements of an implementation strategy, as set forth in 26 CFR 1.501(r)-3 (c).
(3) "Community health needs assessment" means a community health needs assessment that satisfies the requirements of 26 CFR 1.501(r)-3.
(4) "Community-identified health need" means a health need of a community that is identified in a community health needs assessment.
(5) (a) "Reporting hospital" means:
(I) A hospital licensed as a general hospital pursuant to part 1 of article 3 of title 25 and exempt from federal taxation pursuant to section 501 (c)(3) of the federal internal revenue code;
(II) A hospital established pursuant to section 25-29-103; or
(III) A hospital established pursuant to section 23-21-503.
(b) Notwithstanding subsection (5)(a) of this section, "reporting hospital" does not include a hospital that is licensed as a general hospital with the department of public health and environment and that is:
(I) Federally certified or undergoing federal certification as a long-term care hospital pursuant to 42 CFR 412.23 (e); or
(II) Federally certified or undergoing federal certification as a critical access hospital pursuant to 42 CFR 485 subpart F.
C.R.S. § 25.5-1-702 Hospitals - public community meeting requirement - rules
25.5-1-702. Hospitals - public community meeting requirement - rules. (1) At least once each year, each reporting hospital shall convene a public meeting to seek feedback regarding the reporting hospital's community benefit activities during the previous year and the reporting hospital's community benefit implementation plan for the following year. The presentation of the community benefit activities for the previous year must include the reporting hospital's discrete community benefit activities, the amount funded for each activity, and a description of how the activities and funding amounts align with the community's identified priorities.
(2) (a) Each reporting hospital shall invite, at a minimum, representatives from the following entities to participate in the meeting described in subsection (1) of this section, if any such entities operate in the reporting hospital's community:
(I) Local public health agencies;
(II) Local chambers of commerce and economic development organizations;
(III) Local health-care consumer organizations;
(IV) School districts;
(V) County governments;
(VI) City and town governments;
(VII) Community health centers;
(VIII) Certified rural health clinics or primary care clinics located in a county that has been designated by the federal office of management and budget as a rural or frontier county;
(IX) Area agencies on aging;
(X) Health-care consumer advocacy organizations;
(XI) A member of the tribal council or the member's designee for a hospital whose community includes one of Colorado's land-based tribes;
(XII) A member from the urban Indian organization for a hospital whose community includes a federally designated urban Indian health center or urban Indian organization; and
(XIII) A member from an institution of higher education for a hospital whose community includes such institutions.
(b) In addition to the entities described in subsection (2)(a) of this section, each reporting hospital shall invite, at a minimum, representatives from the following state agencies to participate in the meeting described in subsection (1) of this section:
(I) The state department;
(II) The department of public health and environment;
(III) The department of human services;
(IV) The Colorado commission on higher education; and
(V) The office of saving people money on healthcare in the lieutenant governor's office.
(c) In addition to the entities described in subsections (2)(a) and (2)(b) of this section, each reporting hospital shall invite the general public to the annual meeting described in subsection (1) of this section. The reporting hospital shall issue such invitation in an advertisement placed in any major newspaper published in the reporting hospital's community, posted on the reporting hospital's public website and social media accounts or other online presence, distributed through the reporting hospital's electronic newsletter or e-mail lists, and distributed by any other means through which the reporting hospital regularly communicates with the community it serves. The invitation must be published at least thirty days prior to the scheduled meeting.
(2.5) When presenting the proposed community benefit implementation plan described in subsection (1) of this section, the reporting hospital must:
(a) Present priority areas identified in the reporting hospital's most recent community health needs assessment and any other community benefit investment option recommended by the reporting hospital. Each priority recommendation presented must clearly identify the source of the recommendation.
(b) Solicit public input for any additional community benefit investment priority; and
hospital must:
(a) Present priority areas identified in the reporting hospital's most recent community health needs assessment and any other community benefit investment option recommended by the reporting hospital. Each priority recommendation presented must clearly identify the source of the recommendation.
(b) Solicit public input for any additional community benefit investment priority; and
(c) Review and incorporate the public feedback received before the reporting hospital finalizes its annual community benefit implementation plan.
(2.7) A reporting hospital may only add community benefit priorities to the reporting hospital's implementation plan if the community benefit priorities were presented at the annual meeting and the public was provided an opportunity to provide feedback. The reporting hospital must indicate that the implemented community benefit priorities are a result of reporting hospital recommendations and not from community feedback.
(2.8) The state board shall promulgate rules to define terms and establish specific processes regarding the requirements for reporting hospitals to solicit, review, and incorporate public input pursuant to subsections (2.5) and (2.7) of this section.
(3) To satisfy the requirements of this section, a reporting hospital may convene a joint public meeting with one or more other reporting hospitals that share some or all of the hospital's community.
(4) For each public meeting and community health needs assessment community engagement meeting held, each reporting hospital shall submit a report to the state department and make the report available to community members by making the report publicly available on the reporting hospital's website. The report must include, at a minimum, the following:
(a) Meeting minutes;
(b) A list of the meeting attendees;
(c) The content of the meeting discussion, including any community benefit priorities discussed and the decisions made regarding those discussed community benefit priorities;
(d) Community feedback received and how the hospital plans to incorporate the feedback into the reporting hospital's community benefit implementation plan; and
(e) Any data collected from attendees, such as data concerning race, ethnicity, or income.
(5) The state department must conduct a stakeholder meeting with consumer advocates, community organizers, community organizations, and hospital representatives to identify and develop, at a minimum, best practices to ensure low-income residents, residents of color, people with serious mental illness, people with disabilities, and other populations experiencing disproportionate health outcomes in local communities are meaningfully engaged and to ensure their input is incorporated into the data used to identify community priorities for the community health needs assessment and community benefit implementation plan. This stakeholder engagement must also include best practices for hospitals to collaborate with local public health agencies and community organizations to reduce redundant community needs assessments.
(6) The state board shall promulgate rules to establish accommodation standards for the annual community benefit public meetings and community health needs assessment that include language accessibility, adequate advanced public notice, and any other type of accessibility measures deemed necessary by the state board, and to implement the best practices identified and developed pursuant to subsection (5) of this section.
(7) The state board shall promulgate any additional rules that may be necessary for conducting the annual community benefit public meetings described in this section.
C.R.S. § 25.5-1-703 Hospitals - community health needs assessments - community benefit implementation plans - reports - rules
25.5-1-703. Hospitals - community health needs assessments - community benefit implementation plans - reports - rules. (1) On or before a date to be determined by rules promulgated by the state board, and on or before such date every three years thereafter, each reporting hospital shall complete a community health needs assessment.
(2) On or before a date to be determined by rules promulgated by the state board, and on or before such date each year thereafter, each reporting hospital shall complete a community benefit implementation plan that:
(a) Addresses the needs described by the reporting hospital's community health needs assessment;
(b) Includes an explanation of the community served by the reporting hospital; and
(c) Describes how the community was determined pursuant to 26 CFR 1.501(r)-3 (b).
(3) On or before a date to be determined by rules promulgated by the state board, and on or before such date each year thereafter, each reporting hospital shall prepare and submit to the state department a report on certain community benefits, costs, and shortfalls. The report must include:
(a) The reporting hospital's most recent community health needs assessment completed pursuant to subsection (1) of this section;
(b) The reporting hospital's community benefit implementation plan for the coming year completed pursuant to subsection (2) of this section;
(c) A copy of the reporting hospital's most recent form 990 submitted to the federal internal revenue service; and
(d) A description of certain spending and investments made by the reporting hospital during the preceding year, including:
(I) A list of the investments made by the reporting hospital that were included in part I, part II, and part III of schedule H of the reporting hospital's form 990. For each such investment, the reporting hospital shall:
(A) Indicate the cost of the investment;
(B) Indicate whether the investment addressed a community-identified health need;
(C) For any investment that addressed a community-identified health need, identify any of the following categories, which may be further defined by rules promulgated by the state board, that are applicable: Free or discounted health-care services; behavioral health; community-based health care; social determinants of health spending, including spending to address individuals' needs, such as housing, food, transportation, interpersonal violence, education, and job opportunities; and provider recruitment, education, and research and training. In identifying these categories, the reporting hospital shall distinguish direct or cash expenditures from in-kind contributions.
(D) For any investment that addressed a community-identified health need, provide evidence showing how the investment improves community health outcomes and how the investment directly corresponds to community-identified needs.
(II) The reporting hospital's total expenses included in line 18 of section 1 of the form 990 submitted by the reporting hospital or by the reporting hospital's ownership entity; and
(III) The reporting hospital's revenue less expenses included in line 19 of section 1 of the form 990 submitted by the reporting hospital or by the reporting hospital's ownership entity.
(3.5) On or before a date to be determined by rules promulgated by the state board, and on or before such date every three years thereafter, the state department shall review each reporting hospital's community health needs assessment and each reporting hospital's annual community benefit implementation plan to identify the highest priority areas as reported by communities as compared to the reporting hospital's reported spending. The state department shall include such information in the report described in subsection (7) of this section.
(4) A reporting hospital that prepares and submits a report pursuant to subsection (3) of this section shall post the report to the reporting hospital's public website.
entify the highest priority areas as reported by communities as compared to the reporting hospital's reported spending. The state department shall include such information in the report described in subsection (7) of this section.
(4) A reporting hospital that prepares and submits a report pursuant to subsection (3) of this section shall post the report to the reporting hospital's public website.
(5) (a) The state board shall promulgate rules that establish:
(I) Reporting requirements for reporting hospitals that are not required to complete schedule H of the form 990. The rules must promote uniformity with the requirements set forth in subsection (3) of this section.
(II) Requirements for the evidence-based supporting documentation that is required pursuant to subsection (3)(d)(I)(D) of this section.
(b) A general hospital that is licensed as a general hospital pursuant to part 1 of article 3 of title 25 and that is not a reporting hospital may submit a report on certain community benefits, costs, and shortfalls that is consistent with this section.
(6) To facilitate the submission of the reports described in subsection (3) of this section, the state department shall develop and provide a website at which each reporting hospital shall submit the reports. The state department shall ensure that the website and the reports remain available to the public.
(7) As part of the report authorized in section 25.5-4-402.8, the state department shall include a summary of the reports submitted to the state department pursuant to subsection (3) of this section during the preceding year. The summary must include:
(a) The amount that each reporting hospital invested in:
(I) Free or reduced-cost health-care services that addressed community-identified health needs;
(II) Programs that addressed health behaviors or risks;
(III) Programs that addressed social determinants of health; and
(IV) All services and programs that addressed community-identified health needs;
(b) A summary of the reporting hospitals' investments that have been effective in improving community health outcomes;
(c) Any legislative recommendations the state department has for the general assembly; and
(d) The estimated federal and state income tax exemptions and the property tax exemptions received by each hospital, which shall be calculated by the department of revenue.
(8) The state department shall post the reports completed pursuant to subsection (7) of this section to a public web page that the state department creates for this sole purpose.
C.R.S. § 25.5-1-704 Hospital community investment compliance - rules
25.5-1-704. Hospital community investment compliance - rules. (1) (a) If the state department finds that a reporting hospital is not in compliance with the community benefit requirements of this part 7, the state department shall notify the reporting hospital of its noncompliance and identify the information that needs to be provided. If a reporting hospital does not comply, the state department shall require the reporting hospital to submit to the state department a corrective action plan within one hundred and twenty days for approval by the state department.
(b) If noncompliance continues or a reporting hospital fails to submit a corrective action plan, or if the state department determines a hospital's noncompliance with this section is knowing or willful or a repeated pattern of noncompliance exists, the state department shall consider the size of the hospital and the seriousness of the violation in setting a fine amount. For a reporting hospital owned by or affiliated with a hospital system comprised of three or more hospitals, the fine must be not more than twenty thousand dollars per week per violation. For all other reporting hospitals, the fine must be not more than five thousand dollars per week per violation.
(2) Reporting hospitals shall expend the amount fined pursuant to subsection (1)(b) of this section on community benefit investment priorities described in the hospital's current community benefit implementation plan within one year after the fine is imposed. Each reporting hospital shall report on how the money collected through fines is expended in the reporting hospital's annual report to the state department pursuant to section 25.5-1-703.
(3) The state board shall promulgate any rules necessary for the implementation of this section.
C.R.S. § 25.5-1-801 Definitions
25.5-1-801. Definitions. As used in this section, unless the context otherwise requires:
(1) "Nonemergency medical transportation" means transportation to or from medically necessary nonemergency treatment.
(2) "Nonmedical transportation" means transportation to enable passengers who are medicaid members to gain access to waiver and other community services, activities, and resources.
(3) "Transportation broker" means an entity designated by the department of health care policy and financing to administer nonemergency medical transportation.
(4) "Transportation provider" means an individual or business entity, other than a transportation broker, that:
(a) Provides transportation services; or
(b) Arranges the facilitation of transportation services by an individual.
(5) "Transportation services" means nonemergency medical transportation or nonmedical transportation services provided to medicaid members.
C.R.S. § 25.5-1-802 Medicaid transportation services - safety and oversight - rules
25.5-1-802. Medicaid transportation services - safety and oversight - rules. (1) The state department shall collaborate with stakeholders, including, but not limited to, disability and consumer advocates, PACE providers operating pursuant to section 25.5-5-412, transportation brokers, and transportation providers, to establish rules and processes for the safety and oversight of nonmedical transportation services and nonemergency medical transportation services provided to medicaid members pursuant to articles 4 to 6 of this title 25.5. The rules and processes must:
(a) Ensure the safety of passengers;
(b) Protect passenger access to transportation services; and
(c) Establish driver and vehicle requirements that minimize financial and administrative burdens for transportation providers, direct support professionals as defined in section 25.5-6-406, long-term care direct care workers, independent contractors, and employees providing transportation services.
(2) To the extent possible, the state department shall use existing oversight procedures to ensure compliance with the requirements as described in subsection (1) of this section.
(3) If a provider of transportation services already complies with transportation safety standards established by another state department which meet or exceed the rules and processes established pursuant to subsection (1) of this section, demonstrating such compliance to the state department is sufficient to verify compliance with the requirements of this section.
C.R.S. § 25.5-1-901 Legislative declaration
25.5-1-901. Legislative declaration. (1) The general assembly finds and declares that:
(a) Section 1001 of the "Patient Protection and Affordable Care Act", Pub.L. 111-148, as amended by the "Health Care and Education Reconciliation Act of 2010", Pub.L. 111-152, amended Title XXVII of the "Public Health Service Act", Pub.L. 78-410, in part, by adding a new section 2718 (e), requiring, in part, that each hospital operating within the United States establish, update, and make public a list of the hospital's standard charges for the items and services that the hospital provides;
(b) Effective January 1, 2021, the federal centers for medicare and medicaid services published the final rule to implement the law, codified at 45 CFR 180;
(c) In its summary of the final rule, CMS states that information on hospital standard charges is necessary for the public to "make more informed decisions about their care" and that the "impact of these final policies will help to increase market competition, and ultimately drive down the cost of health care services, making them more affordable for all patients";
(d) On July 9, 2021, President Biden, building upon efforts of past presidents, issued the "Executive Order on Promoting Competition in the American Economy", directing the secretary of the United States department of health and human services to support new and existing price transparency initiatives for hospitals;
(e) Health-care price transparency is in the best interest of all Coloradans, including:
(I) The state government, which purchases health-care services for almost one-fourth of all Coloradans;
(II) Colorado businesses, which fund employee medical expenses; and
(III) Colorado residents, who ultimately bear the brunt of high health-care costs in the form of higher taxes, lower wages, and residents' own out-of-pocket spending;
(f) Moreover, health-care prices in Colorado are among the highest in the nation;
(g) However, not all Colorado hospitals are in compliance with all of the disclosure requirements under federal law and other state laws governing health-care price transparency; and
(h) This lack of compliance with health-care price transparency laws by Colorado hospitals decreases the likelihood that Colorado consumers will be fully aware of affordable health-care options before purchasing items and services from hospitals, placing health-care consumers at greater risk of collection actions and other adverse actions relating to unpaid medical bills.
(2) Therefore, the general assembly finds and declares that it is imperative to protect Colorado health-care consumers from collection actions and other adverse actions taken by Colorado hospitals during the time when the hospital was not in material compliance with hospital price transparency laws intended to protect health-care consumers.
C.R.S. § 25.5-1-902 Definitions
25.5-1-902. Definitions. As used in this part 9, unless the context otherwise requires:
(1) "Collection action" means any of the following actions taken with respect to a debt for items and services that were purchased from or provided to a patient by a hospital on a date during which the hospital was not in material compliance with hospital price transparency laws:
(a) Attempting to collect a debt from a patient or patient guarantor by referring the debt, directly or indirectly, to a debt collector, a collection agency, or other third party retained by or on behalf of the hospital;
(b) Suing the patient or patient guarantor or enforcing an arbitration or mediation clause in any hospital documents, including contracts, agreements, statements, or bills; or
(c) Directly or indirectly causing a report to be made to a consumer reporting agency.
(2) (a) "Collection agency" means any:
(I) Person who engages in a business, the principal purpose of which is the collection of debts; or
(II) Person who:
(A) Regularly collects or attempts to collect, directly or indirectly, debts owed or due or asserted to be owed or due to another;
(B) Takes assignment of debts for collection purposes;
(C) Directly or indirectly solicits for collection debts owed or due or asserted to be owed or due to another; or
(D) Collects debt for the department of personnel.
(b) "Collection agency" does not include:
(I) Any officer or employee of a creditor while, in the name of the creditor, collecting debts for such creditor;
(II) Any person while acting as a collection agency for another person, both of whom are related by common ownership or affiliated by corporate control, if the person acting as a collection agency does so only for creditors to whom it is so related or affiliated and if the principal business of the person is not the collection of debts;
(III) Any officer or employee of the United States or any state to the extent that collecting or attempting to collect any debt is in the performance of the officer's or employee's official duties;
(IV) Any person while serving or attempting to serve legal process on any other person in connection with the judicial enforcement of any debt;
(V) Any debt-management services provider operating in compliance with or exempt from the "Uniform Debt-Management Services Act", part 2 of article 19 of title 5;
(VI) Any person collecting or attempting to collect any debt owed or due or asserted to be owed or due another to the extent that:
(A) The activity is incidental to a bona fide fiduciary obligation or a bona fide escrow arrangement;
(B) The activity concerns a debt that was extended by the person;
(C) The activity concerns a debt that was not in default at the time it was obtained by the person; or
(D) The activity concerns a debt obtained by the person as a secured party in a commercial credit transaction involving the creditor;
(VII) Any person whose principal business is the making of loans or the servicing of debt not in default and who acts as a loan correspondent, seller and servicer for the owner, or holder of a debt that is secured by a deed of trust on real property, whether or not the debt is also secured by an interest in personal property; or
(VIII) A limited gaming or racing licensee acting pursuant to article 33 of title 44.
whose principal business is the making of loans or the servicing of debt not in default and who acts as a loan correspondent, seller and servicer for the owner, or holder of a debt that is secured by a deed of trust on real property, whether or not the debt is also secured by an interest in personal property; or
(VIII) A limited gaming or racing licensee acting pursuant to article 33 of title 44.
(c) Notwithstanding the provisions of subsection (2)(b) of this section, "collection agency" includes any person who, in the process of collecting the person's own debts, uses another name that would indicate that a third person is collecting or attempting to collect such debts.
(3) (a) "Consumer reporting agency" means any person that, for monetary fees or dues or on a cooperative nonprofit basis, regularly engages, in whole or in part, in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties. "Consumer reporting agency" includes any person defined in 15 U.S.C. sec. 1681a (f) or section 5-18-103 (4).
(b) "Consumer reporting agency" does not include any business entity that provides check verification or check guarantee services only.
(4) (a) "Debt" means any obligation or alleged obligation of a consumer to pay money arising out of a transaction, whether or not the obligation has been reduced to judgment.
(b) "Debt" does not include a debt for business, investment, commercial, or agricultural purposes or a debt incurred by a business.
(5) "Debt collector" means any person employed or engaged by a collection agency to perform the collection of debts owed or due or asserted to be owed or due to another.
(6) "Federal centers for medicare and medicaid services" or "CMS" means the centers for medicare and medicaid services in the United States department of health and human services.
(7) "Hospital" means, consistent with 45 CFR 180.20, a hospital:
(a) Licensed or certified by the department of public health and environment pursuant to section 25-1.5-103 (1)(a); or
(b) Approved by the department of public health and environment as meeting the standards established for licensing a hospital.
(8) "Hospital price transparency laws" means section 2718 (e) of the "Public Health Service Act", Pub.L. 78-410, as amended, and rules adopted by the United States department of health and human services implementing section 2718 (e).
(9) "Items and services" or "items or services" means "items and services" as defined in 45 CFR 180.20.
C.R.S. § 25.5-1-903 Failure to comply with hospital price transparency laws - prohibiting collection of debt - penalty
25.5-1-903. Failure to comply with hospital price transparency laws - prohibiting collection of debt - penalty. (1) A hospital that is not in material compliance with hospital price transparency laws on the date that items or services are purchased from or provided to a patient by the hospital shall not initiate or pursue a collection action against the patient or patient guarantor for a debt owed for the items or services.
(2) If a patient believes that a hospital was not in material compliance with hospital price transparency laws on the date that items or services were purchased by or provided to the patient, and the hospital takes a collection action against the patient or patient guarantor, the patient or patient guarantor may file suit to determine if:
(a) The hospital was materially out of compliance with hospital price transparency laws, rules, or regulations on the date the items or services were provided; and
(b) The noncompliance is related to the items or services. The hospital shall not take a collection action against the patient or patient guarantor while the lawsuit is pending.
(3) If a judge or jury, considering compliance standards issued by the federal centers for medicare and medicaid services, finds a hospital to be materially out of compliance with hospital price transparency laws, rules, or regulations, the hospital shall:
(a) Refund the payer any amount of the debt the payer has paid and shall pay a penalty to the patient or patient guarantor in an amount equal to the total amount of the debt;
(b) Dismiss or cause to be dismissed any court action with prejudice and pay any attorney fees and costs incurred by the patient or patient guarantor relating to the action;
(c) Remove or cause to be removed from the patient's or patient guarantor's credit report any report made to a consumer reporting agency relating to the debt; and
(d) Notify the state department of the material noncompliance with hospital price transparency laws, rules, or regulations.
(4) Nothing in this part 9:
(a) Prohibits a hospital from billing a patient, patient guarantor, or third-party payer, including a health insurer, for items or services provided to the patient; or
(b) Requires a hospital to refund any payment made to the hospital for items or services provided to the patient, so long as no collection action is taken in violation of this part 9.
C.R.S. § 25.5-1-904 Transparency - hospitals - standard charges - shoppable services - enforcement
25.5-1-904. Transparency - hospitals - standard charges - shoppable services - enforcement. (1) On or before October 1, 2023, each hospital shall make public and post the hospital's medicare reimbursement rates, if applicable.
(2) (a) The state department shall conduct performance assessments for adherence to federal transparency rules by:
(I) Reviewing relevant information provided to the state department concerning a hospital's performance assessment in connection with this section;
(II) Auditing hospital websites for performance relative to federal price transparency rules, and in evaluating performance, the state department shall follow rules, standards, and guidance published by the federal centers for medicare and medicaid; and
(III) Confirming that each hospital submitted the lists required by this section.
(b) If the state department determines that a hospital has performed poorly in its performance assessment, the state department may:
(I) Issue a written notice to the hospital that clearly explains the manner in which the state department determined that the hospital performed poorly on the adherence to price transparency; and
(II) Provide technical assistance to the hospital to improve performance.
(3) On or before February 1, 2024, the state department shall create and maintain a publicly available list on its website of hospitals that perform poorly on the state department's performance assessment. Such notices and communications are subject to public disclosure under 5 U.S.C. sec. 552, as amended, notwithstanding any exemptions or exclusions to the contrary, in full without redaction. The state department shall update the list at least annually.
(4) A person that violates subsection (1) of this section commits a deceptive trade practice under section 6-1-105.
C.R.S. § 25.5-1-1001 Hospital collaborative agreements - review of proposed collaborative agreements - immunity - legislative declaration - definitions - rules
25.5-1-1001. Hospital collaborative agreements - review of proposed collaborative agreements - immunity - legislative declaration - definitions - rules. (1) The general assembly finds and declares that:
(a) (I) Frontier and rural hospitals continue to struggle to deliver high-quality, accessible, low-cost care due to the rising costs of medications, supplies, medical equipment, and contract labor;
(II) Frontier and rural hospitals are largely independent governmental facilities that are governed by local community boards;
(III) Frontier and rural hospitals are generally separated by large distances and are challenged by the need to provide essential services to local communities due to the sparse population in rural areas;
(IV) Frontier and rural hospitals are increasingly challenged by complex requirements imposed by government and private payers that disproportionately negatively impact these providers and unnecessarily drive up administrative costs; and
(V) In cases where the state department, the division of insurance, if applicable, and the attorney general approve collaborative arrangements, it is the general assembly's intent to provide protection to frontier and rural hospitals from certain antitrust scrutiny that impedes frontier and rural hospitals from working collaboratively to improve quality, increase access, and reduce costs of care to the communities they serve;
(b) (I) Forty-seven of Colorado's sixty-four counties include rural and frontier communities yet contain only twelve percent of Colorado's population;
(II) Thirty-two counties are served by critical access hospitals that have twenty-five or fewer beds and are generally located more than thirty-five miles from the next closest hospital; eleven counties lack any hospital;
(III) The scarcity of nearby hospitals causes many residents to struggle to find quality, affordable health care near their homes;
(IV) Further, many residents in Colorado's rural and frontier communities forgo preventive and behavioral health care and lack comprehensive or specialized care or choice in health-care services, and twenty-four counties in Colorado are considered maternal care "deserts";
(V) Where hospitals do exist in rural and frontier areas, those hospitals receive low reimbursement rates due to a preponderance of government payers and declining local tax dollars, which results in a reduced amount of money available to invest in expanding or upgrading facilities or to purchase necessary, new, or innovative medical supplies, equipment, or technology;
(VI) Many hospitals in rural and frontier communities have difficulty recruiting and retaining qualified health-care professionals and making available needed services; and
(VII) County public hospitals, health service districts, and hospital affiliates perform essential public functions on behalf of the state;
(c) As part of the government's interest in providing needed health-care services in Colorado's rural and frontier communities, it is important for the government to support efforts to find collaborative, innovative solutions to the many problems confronting rural health care, including collaborative or coordinated activities that offer the opportunity to expand health-care options through joint purchasing and staffing, shared services, and joint acquisition of new and expensive diagnostic and treatment solutions;
(d) It is the general assembly's intent to exempt from state antitrust laws, and to provide state action immunity from federal antitrust laws for, certain activities that might be characterized as anticompetitive or that might result in the displacement of competition in the provision of hospital, physician, or other health-care-related services or administrative or general business services; and
(d) It is the general assembly's intent to exempt from state antitrust laws, and to provide state action immunity from federal antitrust laws for, certain activities that might be characterized as anticompetitive or that might result in the displacement of competition in the provision of hospital, physician, or other health-care-related services or administrative or general business services; and
(e) In order to promote improved quality of, increase access to, and reduce costs of health-care services in rural and frontier communities through collaborative agreements authorized by this section, the general assembly further intends to provide a system of review of relevant collaborative agreements by the state department, the division of insurance, if applicable, and the attorney general to ensure that any potential benefits of such collaborative agreements are not outweighed by the harm to competition in rural and frontier communities.
(2) As used in this section, unless the context otherwise requires:
(a) "Collaborative agreement" means an agreement or similar arrangement between two or more hospitals or hospital affiliates that complies with the requirements set forth in this section.
(b) "County public hospital" means a public hospital established pursuant to section 25-3-301.
(c) "Division of insurance" means the division of insurance in the department of regulatory agencies.
(d) "Health service district" has the same meaning as set forth in section 32-1-103 (9).
(e) "Hospital" means a facility with fewer than fifty beds that is:
(I) A county public hospital;
(II) A hospital established, maintained, or operated directly or indirectly by a health service district; or
(III) A hospital affiliate.
(f) "Hospital affiliate" means an affiliate of a county public hospital or health service district that is under the sole control of the county public hospital or health service district.
(3) Except as provided in subsection (4) of this section, and subject to the requirements in subsections (5), (6), and (7) of this section, a hospital is authorized to enter into collaborative agreements with one or more hospitals or hospital affiliates to engage in the following activities:
(a) Ancillary clinical services, acquisition of equipment, clinic management, or health-care provider recruitment;
(b) Joint purchasing or leasing arrangements, including the joint purchasing or leasing of:
(I) Medical and general supplies;
(II) Medical and general equipment;
(III) Pharmaceuticals; or
(IV) Temporary staffing through a staffing agency;
(c) Consulting services with a focus on public health in rural or frontier communities and non-hospital-specific innovations in health-care delivery in those communities;
(d) Purchasing joint professional, general liability, or property insurance;
(e) Sharing back-office services, such as sharing a business office, accounting and finance services, human resources, and risk management and compliance services, but not including sharing service charging expenses or rates among hospitals;
(f) Sharing data services, including shared services for electronic health records and data extraction and analysis services, charge management, and population health analysis; and
services, such as sharing a business office, accounting and finance services, human resources, and risk management and compliance services, but not including sharing service charging expenses or rates among hospitals;
(f) Sharing data services, including shared services for electronic health records and data extraction and analysis services, charge management, and population health analysis; and
(g) Negotiating with health insurance or government payers, which negotiations are limited to:
(I) Shared care protocols intended to improve patient management and outcomes, including implementation of evidence-based protocols, clinical pathways, and recognized best practices in the care and treatment of patients, including clinical therapies, nutrition, exercise, diagnostic testing, and medication management;
(II) Collaborative efforts with payers to promote appropriate and essential services to be provided in the local community;
(III) Management of prior authorization requests; and
(IV) Analysis of aggregate data to compare costs of procedures and to analyze patient outcomes.
(4) Notwithstanding any collaborative agreements described in subsection (3) of this section, the immunity and protections granted to hospitals and hospital affiliates entering into collaborative agreements pursuant to this section do not extend to collaborative agreements with another hospital or hospital affiliate that have the effect of:
(a) Setting reimbursement rates or other compensation from any commercial self-insured or commercial health insurance or government payer;
(b) Dividing or allocating among hospitals or hospital affiliates specific markets for the delivery of any general acute care or specialty lines of health-care services; or
(c) Negotiating or agreeing to compensation under health-care staffing arrangements for hospital employees that results in a reduction of wages of hospital staff, whether employed by the hospital, a staffing agency, or other employer.
(5) Prior to engaging in any joint activity described by a proposed collaborative agreement executed pursuant to subsection (3) of this section, the hospitals or hospital affiliates shall jointly submit the proposed collaborative agreement to the state department and to the division of insurance, if the proposed collaborative agreement includes negotiating with health insurance payers as described in subsection (3)(g) of this section, pursuant to rules that may be promulgated for the submission and review of proposals by the state department and by the division of insurance, if applicable. The state department and the division of insurance, if applicable, may request additional information necessary to review the proposal.
(6) Within fifteen days after receipt of a proposed collaborative agreement and the receipt of additional information requested by the state department and by the division of insurance, if applicable, if the state department and the division of insurance, if applicable, conclude that a proposed collaborative activity will result in cost savings or other efficiencies that will improve or expand the delivery of health-care services in rural and frontier communities in Colorado, the state department and the division of insurance, if applicable, shall refer the proposal to the attorney general to determine, pursuant to rules that may be promulgated for such purpose, that the benefits of the collaborative activity are not outweighed by any anticompetitive harm that may arise from the collaborative activity.
health-care services in rural and frontier communities in Colorado, the state department and the division of insurance, if applicable, shall refer the proposal to the attorney general to determine, pursuant to rules that may be promulgated for such purpose, that the benefits of the collaborative activity are not outweighed by any anticompetitive harm that may arise from the collaborative activity.
(7) Within forty-five days after receiving a referral and review from the state department and the division of insurance, if applicable, the attorney general shall review the proposed collaborative agreement and either approve or deny the proposed collaborative agreement or request additional information related to the proposal. If a request for additional information is made, the attorney general has an additional forty-five days to complete the review following receipt of the requested information.
(8) (a) A collaborative agreement is approved if:
(I) The state department and the division of insurance, if applicable, conclude that the proposed collaborative agreement will result in improved quality, increased access or cost savings, or other efficiencies that will improve or expand the delivery of health-care services in rural and frontier communities in Colorado; and
(II) The attorney general concludes that the benefits identified by the state department and by the division of insurance, if applicable, are outweighed by any competitive concerns identified by the attorney general, or the attorney general does not respond within the time frames specified in subsection (7) of this section.
(b) (I) Except as provided in subsection (8)(b)(III) of this section, if a proposed collaborative agreement is denied, the hospitals or hospital affiliates may request reconsideration by resubmitting the proposed agreement to the attorney general within thirty days after the denial along with additional materials, information, or other evidence that was not previously submitted relating to the determination of the benefits or anticompetitive harm associated with the proposed collaborative agreement.
(II) The attorney general has forty-five days from the date of the request to reconsider the denial and may consult with the state department and the division of insurance as part of the reconsideration. The proposed collaborative agreement is not deemed approved if the attorney general fails to respond within the forty-five-day reconsideration period.
(III) A request for reconsideration of a proposed collaborative agreement may be made only once within the thirty-day period following the denial of the proposed collaborative agreement. The attorney general's decision on a proposed collaborative agreement that is not submitted for reconsideration within thirty days or that is denied upon reconsideration is final and non-appealable.
(c) The state department, the division of insurance, if applicable, or the attorney general may review a collaborative agreement annually to ensure the outcomes related to the collaborative agreement are consistent with this section.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-25.5.docxFetched: 10/6/2026