(1) To improve health outcomes and lower health-care costs, the state department may develop payments to providers that are based on quantifiable performance or measures of quality of care. These performance-based payments may include, but are not limited to, payments to:
(a) Primary care providers;
(b) Federally qualified health centers;
(c) Providers of long-term care services and supports; and
(d) Behavioral health providers, including, but not limited to:
(I) Repealed.
(II) Behavioral health safety net providers, as defined in section 27-50-101; and
(III) Entities contracted with the state department to administer the statewide system of community behavioral health care established in section 25.5-5-402.
(2) (a) Prior to implementing performance-based payments in the medicaid program pursuant to this article 4 and articles 5 and 6 of this title 25.5, including performance-based payments set forth in this section, the state department shall submit to the joint budget committee:
(I) (A) Evidence that the performance-based payments are designed to achieve budget savings; or
(B) A budget request for costs associated with the performance-based payments;
(II) The estimated performance-based payments compared to total reimbursements for the affected service; and
(III) A description of the stakeholder engagement process for developing the performance-based payments, including the participants in the process and a summary of the stakeholder feedback, and the state department's response to stakeholder feedback.
(b) The information required pursuant to subsection (2)(a) of this section must be provided on or before November 1 for performance-based payments that will take effect in the following fiscal year unless the state department includes with its submission an explanation of the need for faster implementation of the payment. If faster implementation is requested, the state department shall provide the information at least three months prior to the implementation of the performance-based payments unless compliance with federal law necessitates shorter notice.
(3) On or before November 1, 2017, and on or before November 1 each year thereafter, the state department shall submit a report to the joint budget committee, the public health care and human services committee of the house of representatives, and the health and human services committee of the senate, or any successor committees, describing rules adopted by the state board and contract provisions approved by the federal centers for medicare and medicaid services in the preceding calendar year that authorize payments to providers based on performance. Notwithstanding the provisions of section 24-1-136 (11)(a)(I), the report required pursuant to this subsection (3) continues indefinitely. The report must include, at a minimum:
(a) A description of performance-based payments included in state board rules, including which performance standards are targeted with each performance-based payment;
(b) A description of the goals and objectives of the performance-based payments, and how those goals and objectives align with other quality improvement initiatives;
(c) A summary of the research-based evidence for the performance-based payments, to the extent such evidence is available;
(d) A summary of the anticipated impact and clinical and nonclinical outcomes of implementing the performance-based payments;
(e) A description of how the impact or outcomes will be evaluated;
(f) An explanation of steps taken by the state department to limit the administrative burden on providers;
(g) A summary of the stakeholder engagement process with respect to each performance-based payment, including major concerns raised through the stakeholder process and how those concerns were remediated;
(h) When available, evaluation results for performance-based payments that were implemented in prior years; and
(i) A description of proposed modifications to current performance-based payments.
Source: L. 2017: Entire section added, (HB 17-1353), ch. 231, p. 898, � 3, effective May 23. L. 2018: (1)(d)(II) amended, (HB 18-1431), ch. 313, p. 1892, � 10, effective August 8. L. 2022: (1)(d) amended, (HB 22-1278), ch. 222, p. 1512, � 67, effective July 1. L. 2023: IP(3) amended, (HB 23-1301), ch. 303, p. 1830, � 47, effective August 7.
Editor's note: Subsection (1)(d)(I)(B) provided for the repeal of subsection (1)(d)(I), effective July 1, 2024. (See L. 2022, p. 1512.)
25.5-4-401.5. Review of provider rates - advisory committee - recommendations - repeal. (1) (a) On or before September 1, 2023, the state department shall establish a schedule for an annual review of provider rates paid under the Colorado Medical Assistance Act so that each provider rate is reviewed at least every three years and shall provide the schedule to the advisory committee established pursuant to subsection (3) of this section and the joint budget committee. If the state department receives any petitions or proposals for provider rates to be reviewed or adjusted, the state department shall forward a copy of the petition or proposal to the advisory committee and the joint budget committee.
(b) The state department shall review each of the provider rates scheduled for review pursuant to the process described in this section. The advisory committee or the joint budget committee may, by a majority vote, direct that the state department conduct a review of a provider rate that is not scheduled for review during that year. The advisory committee or the joint budget committee shall notify the state department of the request for an out-of-cycle review by December 1 of the year prior to the year in which the out-of-cycle review will take place. If the state department determines that the request for an out-of-cycle review cannot be conducted, the state department shall provide written notification to the advisory committee and the joint budget committee within thirty days after the request for an out-of-cycle review. The notification must include a description of the reasons the out-of-cycle review cannot be conducted.
(c) (I) The state department may propose to exclude rates from the schedule established pursuant to subsection (1)(a) of this section if those rates are adjusted on a periodic basis as a result of other state statute or federal law or regulation. The state department shall include the proposed list of exclusions with the schedule established pursuant to subsection (1)(a) of this section.
(II) The advisory committee or the joint budget committee may, by a majority vote, direct the state department to include any rate that the state department has proposed to exclude from the schedule.
(2) (a) In the first phase of the review process, the state department shall conduct an analysis of the access, service, quality, and utilization of each service subject to a provider rate review. The state department shall compare the rates paid with available benchmarks, including medicare rates and usual and customary rates paid by private pay parties, and use qualitative tools to assess whether payments are sufficient to allow for provider retention and medicaid member access and to support appropriate reimbursement of high-value services.
(b) Following the analysis required by subsection (2)(a) of this section, the state department shall work with the advisory committee and any stakeholders identified by the state department or the advisory committee to review the analysis and develop strategies for responding to the findings, including any nonfiscal approaches or rebalancing of rates and strategies to address capacity issues that may exist in certain regions of the state.
(c) Following the review required by subsection (2)(b) of this section, the state department shall work with the office of state planning and budgeting to determine achievable goals and executive branch priorities within the statewide budget.
(d) (I) Notwithstanding section 24-1-136 (11)(a)(I), on or before November 1, 2023, and each November 1 thereafter, the state department shall submit a written report to the joint budget committee and the advisory committee on the analysis required pursuant to subsection (2)(a) of this section, a description of the information discussed during the quarterly public meeting conducted pursuant to subsection (2)(e) of this section, and the state department's recommendations on all of the provider rates reviewed pursuant to this section and all of the data relied upon by the state department in making the recommendations. The joint budget committee shall consider the recommendations in formulating the state department's budget.
(II) The state department shall submit, as part of the report required pursuant to this subsection (2)(d), a description of the information discussed during the quarterly public meeting; the state department's response to the public comments received from providers, members, and other interested parties; and an explanation of how the public comments informed the provider rate review process and the recommendations concerning provider rates.
(e) The state department shall conduct a public meeting at least quarterly to inform the state department's review of provider rates paid under the Colorado Medical Assistance Act. The state department shall invite to the public meeting providers, members, and other interested parties directly affected by the services scheduled to be reviewed at the public meeting. At a minimum, each public meeting must consist of, but is not limited to:
(I) A discussion of the analysis and review performed pursuant to subsection (2)(a) of this section; and
(II) Public comments from providers, members, and other interested parties concerning:
(A) The analysis and review performed pursuant to subsection (2)(a) of this section; and
(B) Recommended changes to the provider rate review process that may enhance or improve the process.
(3) (a) There is created in the state department the medicaid provider rate review advisory committee, referred to in this section as the advisory committee, to assist the state department in the review of the provider rate reimbursements under the Colorado Medical Assistance Act. The advisory committee shall:
(I) Review the schedule for annual review of provider rates established by the state department pursuant to subsection (1)(a) of this section and recommend any changes to the schedule;
(II) Review the analysis performed pursuant to subsection (2)(a) of this section and the reports prepared by the state department on its analysis of provider rates pursuant to subsection (2)(d) of this section and provide comments and feedback to the state department and the joint budget committee on the reports;
(III) Review the comments received from providers, members, and other interested parties and the state department's response to the comments required pursuant to subsection (2)(d)(II) of this section;
(IV) Review proposals or petitions received by the advisory committee for provider rates to be reviewed or adjusted;
(V) Determine whether any provider rates not scheduled for review during the next calendar year should be reviewed during that calendar year;
(VI) Recommend to the state department and to the joint budget committee any changes to the process of reviewing provider rates, including measures to increase access to the process, such as by providing for electronic comments by providers and the public; and
(VII) Provide other assistance to the state department and the joint budget committee as requested by the state department or the joint budget committee.
(b) (I) The advisory committee consists of the following seven members:
(A) Three members appointed by the governor;
(B) Two members appointed by the president of the senate, or the president's designee; and
(C) Two members appointed by the speaker of the house of representatives, or the speaker's designee.
(II) Each member appointed to the advisory committee must have proven expertise related to the medical assistance program in one or more of the following areas:
(A) Service delivery or case management services provided to one or more eligible populations;
(B) Provider finance or budget;
(C) Service capacity analysis;
(D) Business processes;
(E) Claims filing or processing; or
(F) Implementation of state and federal medicaid rules, regulations, and guidance.
(III) The state department may make recommendations to the governor, the president of the senate, and the speaker of the house of representatives concerning the qualifications of members appointed to the advisory committee.
(c) The appointing authorities shall make initial appointments to the advisory committee no later than January 1, 2023. In making appointments to the advisory committee, the appointing authorities shall make a concerted effort to include members of diverse political, racial, cultural, income, and ability groups and members from urban and rural areas.
(d) Each member of the advisory committee serves at the pleasure of the official who appointed the member. Each member of the advisory committee serves a four-year term and may be reappointed.
(e) The members of the advisory committee serve without compensation and without reimbursement for expenses.
(f) At the first meeting of the advisory committee, to be held on or after March 1, 2023, the members shall elect a chair and vice-chair from among the members.
(g) The advisory committee shall meet at least once every quarter. The chair may call additional meetings as may be necessary for the advisory committee to complete its duties.
(h) The advisory committee shall develop bylaws and procedures to govern its operations.
(i) On or before December 1, 2023, and each December 1 thereafter, the advisory committee shall present to the joint budget committee an overview of the provider rate review process, a summary of the provider rates that were reviewed, and the strategies for responding to the findings of the provider rate review, including any fiscal or nonfiscal approaches or rebalancing of rates, any advisory committee recommendations for rate adjustments made to the state department, and any recommendations for improving capacity and access to services in regions of the state where reduced capacity results in limited access to services.
(j) (I) This subsection (3) is repealed, effective September 1, 2034.
(II) Prior to repeal, the department of regulatory agencies shall conduct a sunset review of the advisory committee pursuant to the provisions of section 2-3-1203.
Source: L. 2015: Entire section added, (SB 15-228), ch. 288, p. 1177, � 1, effective June 5. L. 2017: (2)(a) and (2)(d) amended, (HB 17-1060), ch. 6, p. 17, � 9, effective March 1. L. 2021: (3)(b)(III)(D) amended, (HB 21-1187), ch. 83, p. 332, � 25, effective July 1, 2024. L. 2022: Entire section amended, (SB 22-236), ch. 410, p. 2897, � 1, effective July 1, 2023 (see editor's note). L. 2023: (2)(d)(I) amended, (SB 23-223), ch. 74, p. 273, � 1, effective April 17. L. 2024: (2)(a), (2)(d)(II), IP(2)(e), IP(2)(e)(II), and (3)(a)(III) amended, (SB 24-176), ch. 152, p. 640, � 34, effective August 7.
Editor's note: (1) Section 3 of chapter 410, (SB 22-236), Session Laws of Colorado 2022, provides that subsection (3) takes effect December 1, 2022, subsection (2)(d) takes effect May 1, 2025, and the remainder of the section takes effect July 1, 2023.
(2) Section 2 of chapter 74, (SB 23-223), Session Laws of Colorado 2023, amended section 3 of chapter 410, (SB 22-236), Session Laws of Colorado 2022, to change the effective date for amendments to subsection (2)(a) by SB 22-236 from July 1, 2023, to April 30, 2023, and to change the effective date for amendments to subsection (2)(d) by SB 22-236 from May 1, 2025, to July 1, 2023.
25.5-4-402. Providers - hospital reimbursement - hospital review program - rules. (1) For all licensed or certified hospitals contracting for services under this article and articles 5 and 6 of this title, except those hospitals operated by the department of human services or those hospitals deemed exempt by the state board, the state department shall pay for inpatient hospital services pursuant to a system of prospective payment, generally based on the elements of a diagnosis-related group system. The state department shall develop and administer a system for ensuring appropriate utilization and quality of care provided by those providers who are reimbursed under this section. Subject to available appropriations, the state department may also make supplemental medicaid payments to certain hospitals. The state board shall promulgate rules to provide for the implementation of this section.
(2) (a) A hospital that receives payment under this article and articles 5 and 6 of this title for telemedicine services shall employ its existing quality-of-care protocols and patient confidentiality guidelines to ensure that such services meet the requirements of this article and articles 5 and 6 of this title.
(b) The executive director of the state department shall adopt rules in furtherance of this subsection (2), including, without limitation, rules to:
(I) Ensure the provision of appropriate care to patients;
(II) Prevent fraud and abuse; and
(III) Establish methods and procedures to avoid overuse of telemedicine services.
(3) (a) In addition to the reimbursement rate process described in subsection (1) of this section and subject to adequate funding being made available pursuant to section 25.5-4-402.4, the Colorado healthcare affordability and sustainability enterprise created in section 25.5-4-402.4 (3) shall pay an additional amount based upon performance to those hospitals that provide services that improve health-care outcomes for their patients, including a performance metric related to workplace violence. The state department shall determine this amount based upon nationally recognized performance measures established in rules adopted by the state board. The state quality standards must be consistent with federal quality standards published by an organization with expertise in health-care quality, including, but not limited to, the federal centers for medicare and medicaid services, the agency for healthcare research and quality, or the national quality forum.
(b) The amount of the payments made pursuant to subsection (3)(a) of this section must be computed annually. For each state fiscal year, the total amount of the payments must be no more than seven percent of the total reimbursements made to hospitals in the previous state fiscal year.
(c) (I) No later than September 1, 2025, the state department and the quality incentives payments subcommittee of the Colorado healthcare affordability and sustainability enterprise board created in section 25.5-4-402.4 (7) shall consult with the department of public health and environment, an association representing nurses working in Colorado hospitals, a representative of the health-care industry who participates in the Colorado medicaid program and does not represent a hospital, a representative from a statewide association of hospitals, a representative from an association representing rural hospitals, a representative from a hospital, the chairs of the house of representatives health and human services committee and the senate health and human services committee, and any other relevant state agencies to:
(A) Develop recommended workplace violence metrics after evaluating available national standards, considering innovative approaches, and accounting for variations across hospitals;
(B) Determine whether any federal or private funds are available to assist hospitals in lowering the number of incidents of workplace violence; and
(C) Develop legislative recommendations.
(II) During the state department's 2026 SMART Act hearing, the state department shall include a progress report on developing recommended workplace violence metrics, determining whether any federal or private funds are available to assist hospitals in lowering the number of incidents of workplace violence, and developing legislative recommendations pursuant to subsection (3)(c)(I) of this section.
(III) The Colorado healthcare affordability and sustainability enterprise board shall include the legislative recommendations developed pursuant to subsection (3)(c)(I)(C) of this section as part of its January 2027 report submitted pursuant to section 25.5-4-402.4 (7)(e).
(4) (a) Subject to federal approval, and notwithstanding any other provision of the Colorado Medical Assistance Act, the state department shall design and implement an evidence-based hospital review program to ensure appropriate utilization of hospital services.
(b) Consistent with federal regulations set forth in 42 CFR 456, the hospital review program may include the following:
(I) Preadmission review;
(II) Continued stay review;
(III) Transfer planning;
(IV) Discharge planning;
(V) Care coordination; and
(VI) Retrospective claims review.
(c) The following factors must be considered in any coverage determinations made pursuant to the hospital review programs:
(I) Information provided, diagnosis determined, and treatment recommended by the treating provider or providers;
(II) Evidence-based clinical coverage criteria and member coverage guidelines as established by the state department;
(III) Nationally recognized utilization and technology assessment guidelines; and
(IV) Industry standard criteria, as appropriate.
(d) (I) The state department shall consult with affected stakeholders prior to implementation of the hospital review program. At a minimum, the state department shall solicit feedback from members, hospitals within Colorado that participate in medicaid, providers participating in the accountable care collaborative pursuant to section 25.5-5-419, and the Colorado healthcare affordability and sustainability enterprise board established in section 25.5-4-402.4 (7). If the state department contracts with a third-party vendor to implement the hospital review program, the state department shall require the vendor to participate in the stakeholder outreach with hospitals required pursuant to this subsection (4)(d)(I).
(II) Prior to implementation of the hospital review program, the state department shall provide an opportunity for hospitals to test connectivity to and workability of any new electronic interface created or implemented as part of this section. The state department shall select a limited group of hospitals to test any new requirements prior to full implementation.
(III) The state department shall provide a report to the joint budget committee by November 1, 2018, on the status of the implementation of the hospital review program. The report must include the comments received as part of the stakeholder process described in subsection (4)(d)(I) of this section and a description of, and any available results from, the testing process described in subsection (4)(d)(II) of this section.
(IV) and (V) Repealed.
(e) The state board shall adopt any rules necessary for the administration and implementation of this section.
Source: L. 2006: Entire article added with relocations, p. 1844, � 7, effective July 1; entire section amended, p. 1546, � 3, effective July 1. L. 2009: (1) amended and (3) added, (HB 09-1293), ch. 152, p. 645, � 4, effective July 1. L. 2017: (3)(a) amended, (SB 17-267), ch. 267, p. 1448, � 15, effective July 1. L. 2018: (4) added, (SB 18-266), ch. 264, p. 1624, � 2, effective May 29. L. 2023: (3)(a) amended, (HB 23-1301), ch. 303, p. 1830, � 48, effective August 7. L. 2024: (4)(c)(II) and (4)(d)(I) amended and (4)(d)(IV) and (4)(d)(V) repealed, (SB 24-176), ch. 152, p. 640, � 35, effective August 7. L. 2025: (3) amended, (SB 25-166), ch. 169, p. 686, � 1, effective August 6.
Editor's note: (1) This section is similar to former � 26-4-405 as it existed prior to 2006.
(2) Amendments to section 26-4-405 by Senate Bill 06-165 were harmonized with this section as it appeared in Senate Bill 06-219.
(3) Section 34 of chapter 267 (SB 17-267), Session Laws of Colorado 2017, provides that the section of the act changing this section does not take effect if the centers for medicare and medicaid services determine that the amendments do not comply with federal law. For more information, see SB 17-267. (L. 2017, p. 1478.) The executive director of the department of health care policy and financing did not notify the revisor of statutes by June 1, 2017, of such determination; therefore, the changes to this section took effect July 1, 2017.
Cross references: For the legislative declaration contained in the 2006 act amending this section, see section 1 of chapter 312, Session Laws of Colorado 2006. For the legislative declaration in SB 17-267, see section 1 of chapter 267, Session Laws of Colorado 2017.
25.5-4-402.3. Providers - hospital - provider fees - legislative declaration - federal waiver - fund created - rules - advisory board - repeal. (Repealed)
Source: L. 2009: Entire section added, (HB 09-1293), ch. 152, p. 633, � 1, effective July 1. L. 2010: (4)(b)(VIII) added, (SB 10-169), ch. 307, p. 1445, � 1, effective May 27; (4)(b)(IV) amended, (HB 10-1422), ch. 419, p. 2110, � 141, effective August 11. L. 2011: (3)(a)(II) and (3)(a)(III) amended and (3)(a)(IV), (4)(b)(IX), and (5)(b.5) added, (SB 11-212), ch. 146, pp. 508, 509, �� 1, 2, 3, effective May 5. L. 2013: (4)(b)(IV)(A) and (4)(b)(IV)(C) amended, (SB 13-200), ch. 216, p. 897, � 1, effective May 13. L. 2017: (5)(b.3) added, (SB 17-256), ch. 198, p. 720, � 1, effective May 8; entire section repealed, (SB 17-267), ch. 267, p. 1448, � 16, effective July 1.
Editor's note: Section 34 of chapter 267 (SB 17-267), Session Laws of Colorado 2017, provides that the section of the act repealing this section does not take effect if the centers for medicare and medicaid services determine that the amendments do not comply with federal law. For more information, see SB 17-267. (L. 2017, p. 1478.) The executive director of the department of health care policy and financing did not notify the revisor of statutes by June 1, 2017, of such determination; therefore, the repeal of this section took effect July 1, 2017.
Cross references: For the legislative declaration in SB 17-267, see section 1 of chapter 267, Session Laws of Colorado 2017.
25.5-4-402.4. Hospitals - healthcare affordability and sustainability hospital provider fee - healthcare affordability and sustainability nursing facility provider fee - healthcare affordability and sustainability intermediate care facility fee - receipt of public funds - Colorado healthcare affordability and sustainability enterprise - federal waiver - funds created - reports - rules - legislative declaration - definitions - repeal. (1) Short title. The short title of this section is the Colorado Healthcare Affordability and Sustainability Enterprise Act of 2017.
(2) Legislative declaration. The general assembly finds and declares that:
(a) The state and the providers of publicly funded medical services, and hospitals, nursing facility providers, and intermediate care facilities for individuals with intellectual disabilities in particular, share a common commitment to comprehensive health-care reform;
(b) Hospitals within the state incur significant costs by providing uncompensated emergency department care and other uncompensated medical services to low-income and uninsured populations;
(c) This section is enacted as part of a comprehensive health-care reform and is intended to provide the following services and benefits to hospitals, nursing facility providers, intermediate care facilities for individuals with intellectual disabilities, and individuals:
(I) Providing a payer source for some low-income and uninsured populations who may otherwise be cared for in emergency departments and other settings in which uncompensated care is provided;
(II) Reducing the underpayment to Colorado hospitals participating in publicly funded health insurance programs;
(III) Reducing the number of persons in Colorado who are without health-care benefits;
(IV) Reducing the need of hospitals and other health-care providers to shift the cost of providing uncompensated care to other payers;
(V) Expanding access to high-quality, affordable health care for low-income and uninsured populations;
(V.5) Sustaining or increasing the reimbursement for providing medical care under the state's medical assistance program for nursing facility providers and making supplemental medicaid payments to nursing facility providers;
(V.7) Maintaining the quality and continuity of services provided by intermediate care facilities for individuals with intellectual disabilities; and
(VI) Providing the additional business services specified in subsection (4)(a)(IV) of this section to hospitals that pay the healthcare affordability and sustainability hospital provider fee charged and collected as authorized by subsection (4) of this section by the Colorado healthcare affordability and sustainability enterprise created in subsection (3)(a) of this section;
(d) The Colorado healthcare affordability and sustainability enterprise provides business services to hospitals when, in exchange for payment of healthcare affordability and sustainability hospital provider fees by hospitals, it:
(I) Obtains federal matching money and returns both the hospital provider fee and the federal matching money to hospitals to increase reimbursement rates to hospitals for providing medical care under the state medical assistance program, including disproportionate share hospital payments pursuant to 42 U.S.C. sec. 1396r-4, and to increase the number of individuals covered by public medical assistance; and
(II) Provides additional business services to hospitals as specified in subsection (4)(a)(IV) of this section;
(d.5) The Colorado healthcare affordability and sustainability enterprise provides business services to nursing facility providers when, in exchange for payment of nursing facility provider fees, it obtains federal matching money and returns both the nursing facility provider fee and the federal matching money to nursing facility providers to sustain or increase reimbursement rates and make supplemental medicaid payments to nursing facility providers;
(d.7) The Colorado healthcare affordability and sustainability enterprise provides business services to intermediate care facilities for individuals with intellectual disabilities when, in exchange for payment of intermediate care facility fees, it obtains federal matching money and returns both the intermediate care facility fee and the federal matching money to intermediate care facilities for individuals with intellectual disabilities to sustain or increase reimbursement rates and make supplemental medicaid payments to such intermediate care facilities;
(e) It is necessary, appropriate, and in the best interest of the state to acknowledge that by providing the business services specified in subsections (2)(d) to (2)(d.7) of this section, the Colorado healthcare affordability and sustainability enterprise engages in an activity conducted in the pursuit of a benefit, gain, or livelihood and therefore operates as a business;
(f) Consistent with the determination of the Colorado supreme court in Nicholl v. E-470 Public Highway Authority, 896 P.2d 859 (Colo. 1995), that the power to impose taxes is inconsistent with enterprise status under section 20 of article X of the state constitution, it is the conclusion of the general assembly that the healthcare affordability and sustainability hospital provider fee, the healthcare affordability and sustainability nursing facility provider fee, the healthcare affordability and sustainability intermediate care facility fee, and the medicaid buy-in premiums charged and collected by the Colorado healthcare affordability and sustainability enterprise are fees, not taxes, because the fees are imposed for the specific purposes of allowing the enterprise to defray the costs of providing the business services specified in subsections (2)(d) to (2)(d.7) and (2)(c) of this section to hospitals and individuals, nursing facility providers, and intermediate care facilities for individuals with intellectual disabilities that pay the fees and are collected at rates that are reasonably calculated based on the benefits received by those hospitals and individuals, nursing facility providers, and intermediate care facilities;
(f.5) Transfers from governmental health-care providers to the enterprise through a mutually executed agreement, and as authorized by 42 CFR 433.51, are not grants under section 20 of article X of the state constitution because:
(I) Participating providers receive federal funds and other business services as described in this section; and
(II) Such transfers must be repaid if they are not utilized or approved, and thus do not meet the definition of grant set forth in section 24-77-102; and
(g) So long as the Colorado healthcare affordability and sustainability enterprise qualifies as an enterprise for purposes of section 20 of article X of the state constitution, the revenues from the fees charged and collected by the enterprise are not state fiscal year spending, as defined in section 24-77-102 (17), or state revenues, as defined in section 24-77-103.6 (6)(c), and do not count against either the state fiscal year spending limit imposed by section 20 of article X of the state constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I).
(3) Colorado healthcare affordability and sustainability enterprise. (a) The Colorado healthcare affordability and sustainability enterprise is created. The enterprise is and operates as a government-owned business within the state department for the purpose of:
(I) Charging and collecting:
(A) The hospital provider fee;
(B) The nursing facility provider fee;
(C) The intermediate care facility fee; and
(D) Medicaid buy-in premiums;
(II) Leveraging revenue from the hospital provider fee, the nursing facility provider fee, and the intermediate care facility fee to obtain federal matching money; and
(III) Utilizing and deploying:
(A) The hospital provider fee revenue and federal matching money to provide the business services specified in subsections (2)(d)(I) and (2)(d)(II) of this section to hospitals that pay the healthcare affordability and sustainability fee;
(B) The nursing facility provider fee revenue and any federal matching money to provide the business services specified in subsection (2)(d.5) of this section to nursing facility providers that pay the nursing facility provider fee;
(C) The intermediate care facility fee revenue and any federal matching money to provide the business services specified in subsection (2)(d.7) of this section to intermediate care facilities for individuals with intellectual disabilities that pay the intermediate care facility fee; and
(D) The medicaid buy-in premium revenue to provide the medicaid buy-in programs created pursuant to part 14 of article 6 of this title 25.5 and section 25.5-5-206, which are services and benefits specified in subsection (2)(c) of this section.
(b) The enterprise constitutes an enterprise for purposes of section 20 of article X of the state constitution so long as it retains the authority to issue revenue bonds and receives less than ten percent of its total revenues in grants from all Colorado state and local governments combined. So long as it constitutes an enterprise pursuant to this subsection (3)(b), the enterprise is not subject to any provisions of section 20 of article X of the state constitution.
(c) (I) The repeal of the hospital provider fee program, as it existed pursuant to section 25.5-4-402.3 before its repeal, effective July 1, 2017, by Senate Bill 17-267, enacted in 2017, and the creation of the Colorado healthcare affordability and sustainability enterprise as a new enterprise to charge and collect a new healthcare affordability and sustainability hospital provider fee as authorized by subsection (4) of this section and provide fee-funded business services to hospitals that replace and supplement services previously funded by the repealed hospital provider fees is the creation of a new government-owned business that provides business services to hospitals as a new enterprise for purposes of section 20 of article X of the state constitution, does not constitute the qualification of an existing government-owned business as an enterprise for purposes of section 20 of article X of the state constitution or section 24-77-103.6 (6)(b)(II), and, therefore, does not require or authorize adjustment of the state fiscal year spending limit calculated pursuant to section 20 of article X of the state constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I).
(II) Notwithstanding subsection (3)(c)(I) of this section, because the repeal of the hospital provider fee program, as it existed pursuant to section 25.5-4-402.3 before its repeal by Senate Bill 17-267, enacted in 2017, will allow the state to spend more general fund money for general governmental purposes than it would otherwise be able to spend below the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I), it is appropriate to restrain the growth of government by lowering the base amount used to calculate the excess state revenues cap for the 2017-18 state fiscal year by two hundred million dollars.
(III) The repeal of the medicaid buy-in cash fund, as it existed in section 25.5-6-1404 (3)(b) before its repeal, effective May 1, 2025, by Senate Bill 25-228, enacted in 2025, and the enterprise's ability to charge and collect the medicaid buy-in premiums and provide premium-funded business services to individuals and hospitals that replace and supplement services previously funded both by the medicaid buy-in premiums and the healthcare affordability and sustainability fee do not constitute creation of a new enterprise or the qualification of an existing government-owned business as an enterprise for purposes of section 20 of article X of the state constitution, section 24-77-103.6 (6)(b)(II), or section 24-77-108, and, therefore, do not require or authorize adjustment of the state fiscal year spending limit calculated pursuant to section 20 of article X of the state constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I), and do not require voter approval.
(IV) The repeal of the nursing facility provider fee program, as it existed in section 25.5-6-203 (1) before its repeal, effective May 1, 2025, by Senate Bill 25-270, enacted in 2025, and the enterprise's ability to charge and collect a new healthcare affordability and sustainability nursing facility provider fee as authorized by subsection (4.5) of this section and provide fee-funded business services to nursing facility providers that replace and supplement services previously funded by the nursing facility provider fee does not constitute creation of a new enterprise or the qualification of an existing government-owned business as an enterprise for purposes of section 20 of article X of the state constitution, section 24-77-103.6 (6)(b)(II), or section 24-77-108, and, therefore, does not require or authorize adjustment of the state fiscal year spending limit calculated pursuant to section 20 of article X of the state constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I), and does not require voter approval.
(V) The repeal of the intermediate care facility service fee program, as it existed in section 25.5-6-204 (1)(c)(I) before its repeal, effective May 1, 2025, by Senate Bill 25-270, enacted in 2025, and the enterprise's ability to charge and collect a new healthcare affordability and sustainability intermediate care facility fee as authorized by subsection (4.7) of this section and provide fee-funded business services to intermediate care facilities for individuals with intellectual disabilities that replace and supplement services previously funded by the intermediate care facility service fee does not constitute creation of a new enterprise or the qualification of an existing government-owned business as an enterprise for purposes of section 20 of article X of the state constitution, section 24-77-103.6 (6)(b)(II), or section 24-77-108, and, therefore, does not require or authorize adjustment of the state fiscal year spending limit calculated pursuant to section 20 of article X of the state constitution or the excess state revenues cap, as defined in section 24-77-103.6 (6)(b)(I), and does not require voter approval.
(d) The enterprise's primary powers and duties are:
(I) To charge and collect:
(A) The hospital provider fee as specified in subsection (4) of this section;
(B) The nursing facility provider fee as specified in subsection (4.5) of this section;
(C) The intermediate care facility fee as specified in subsection (4.7) of this section; and
(D) The medicaid buy-in premiums described in subsection (5.1) of this section and sections 25.5-5-206 and 25.5-6-1404;
(II) To leverage revenue from the hospital provider fee, the nursing facility provider fee, and the intermediate care facility fee to obtain federal matching money, working with or through the state department and the state board to the extent required by federal law or otherwise necessary;
(III) To expend:
(A) Hospital provider fee revenue, matching federal money, and any other money from the hospital provider fee cash fund as specified in subsections (4) and (5) of this section;
(B) Nursing facility provider fee revenue, matching federal money, and any other money from the nursing facility provider fee cash fund as specified in subsection (5.5) of this section;
(C) Intermediate care facility fee revenue, matching federal money, and any other money from the intermediate care facility fee cash fund as specified in subsection (5.7) of this section; and
(D) Medicaid buy-in premium revenue from the buy-in fund as specified in subsection (5.1) of this section;
(IV) To issue revenue bonds payable from the revenues of the enterprise;
(V) To enter into agreements with the state department to the extent necessary to collect and expend revenue from the hospital provider fee, the nursing facility provider fee, and the intermediate care facility fee;
(V.5) To enter into agreements with the state department to the extent necessary to expend money from the hospital provider fee cash fund;
(VI) To engage the services of private persons or entities serving as contractors, consultants, and legal counsel for professional and technical assistance and advice and to supply other services related to the conduct of the affairs of the enterprise, including the provision of additional business services to hospitals as specified in subsection (4)(a)(IV) of this section;
(VII) To adopt and amend or repeal policies for the regulation of its affairs and the conduct of its business consistent with the provisions of this section; and
(VIII) To receive public funds as described in subsection (4) of this section.
(e) The enterprise is a type 2 entity, as defined in section 24-1-105, and exercises its powers and performs its duties and functions under the department.
(4) Healthcare affordability and sustainability hospital provider fee. (a) For the fiscal year commencing July 1, 2017, and for each fiscal year thereafter, the enterprise is authorized to charge and collect a healthcare affordability and sustainability hospital provider fee, as described in 42 CFR 433.68 (b), or as otherwise in compliance with 42 CFR 433, on outpatient and inpatient services provided by all licensed or certified hospitals, and receive public funds as described in 42 CFR 433.51, for the purpose of obtaining federal financial participation under the state medical assistance program as described in this article 4 and articles 5 and 6 of this title 25.5, including disproportionate share hospital payments pursuant to 42 U.S.C. sec. 1396r-4. If the amount of hospital provider fee revenue collected exceeds the federal net patient revenue-based limit on the amount of such fee revenue that may be collected, requiring repayment to the federal government of excess federal matching money received, hospitals that received such excess federal matching money are responsible for repaying the excess federal money and any associated federal penalties to the federal government. The enterprise shall use the hospital provider fee revenue to:
(I) Provide a business service to hospitals by increasing reimbursement to hospitals for providing:
(A) Medical care under the state medical assistance program; and
(B) Hospital financial assistance programs for care provided to uninsured patients;
(II) Provide a business service to hospitals by increasing the number of individuals covered by public medical assistance and thereby reducing the amount of uncompensated care that the hospitals must provide;
(II.3) and (II.5) Repealed.
(III) Pay the administrative costs to the enterprise in implementing and administering this section subject to the limitation that administrative costs of the enterprise are limited to three percent of the enterprise's expenditures based on a methodology approved by the office of state planning and budgeting and the staff of the joint budget committee of the general assembly; and
(IV) Provide or contract for or arrange the provision of additional business services to hospitals by:
(A) Consulting with hospitals to help them improve both cost efficiency and patient safety in providing medical services and the clinical effectiveness of those services;
(B) Advising hospitals regarding potential changes to federal and state laws and regulations that govern the provision of and reimbursement paid for medical services under the programs administered pursuant to this article 4 and articles 5 and 6 of this title 25.5;
(C) Providing coordinated services to hospitals to help them adapt and transition to any new or modified performance tracking and payment systems for the programs administered pursuant to this article 4 and articles 5 and 6 of this title 25.5, which may include data sharing, telehealth coordination and support, establishment of performance metrics, benchmarking to such metrics, and clinical and administrative process consulting and other appropriate services;
(D) Providing any other services to hospitals that aid them in efficiently and effectively participating in the programs administered pursuant to this article 4 and articles 5 and 6 of this title 25.5; and
(E) Providing funding for, and in cooperation with the state department and hospitals supporting the implementation of, a health-care delivery system reform incentive payments program as described in subsection (8) of this section.
(b) The enterprise shall recommend for approval and establishment by the state board the amount of the hospital provider fee that it intends to charge and collect and the amount of public funds that it intends to receive. The state board must establish the final amount of the fee by rules promulgated in accordance with article 4 of title 24. The state board shall not establish any amount that exceeds the federal limit for such fees or public funds. The state board may deviate from the recommendations of the enterprise, but shall express in writing the reasons for any deviations. In establishing the amount of the fee and in promulgating the rules governing the fee, the state board shall:
(I) Consider recommendations of the enterprise;
(II) Establish the amount of the hospital provider fee and public funds so that the amount collected from the fee, the amount received from public funds, and federal matching funds associated with the fee and public funds are sufficient to pay for the items described in subsection (4)(a) of this section, but nothing in this subsection (4)(b)(II) requires the state board to increase the fee or the amount of public funds to be received above the amounts recommended by the enterprise; and
(III) For the 2017-18 fiscal year, establish the amount of the hospital provider fee so that the amount collected from the fee is approximately equal to the sum of the amounts of the appropriations specified for the fee in the general appropriation act, Senate Bill 17-254, enacted in 2017, and any other supplemental appropriation act.
(c) (I) In accordance with the redistributive method set forth in 42 CFR 433.68 (e)(1) and (e)(2), the enterprise, acting in concert with or through an agreement with the state department if required by federal law, may seek a waiver from the broad-based hospital provider fee requirement or the uniform hospital provider fee requirement, or both. In addition, the enterprise, acting in concert with or through an agreement with the state department if required by federal law, shall seek any federal waiver necessary to fund and, in cooperation with the state department and hospitals, support the implementation of a health-care delivery system reform incentive payments program as described in subsection (8) of this section. Subject to federal approval and to minimize the financial impact on certain hospitals, the enterprise may exempt from payment of the hospital provider fee certain types of hospitals, including but not limited to:
(A) Psychiatric hospitals, as licensed by the department of public health and environment;
(B) Hospitals that are licensed as general hospitals and certified as long-term care hospitals by the department of public health and environment;
(C) Critical access hospitals that are licensed and certified by the department of public health and environment under 42 CFR 485, subpart F;
(D) Inpatient rehabilitation facilities; or
(E) Hospitals specified for exemption under 42 CFR 433.68 (e).
(II) In determining whether a hospital may be excluded, the enterprise shall use one or more of the following criteria:
(A) A hospital that is located in a rural area;
(B) A hospital with which the state department does not contract to provide services under the state medical assistance program;
(C) A hospital whose inclusion or exclusion would not significantly affect the net benefit to hospitals paying the hospital provider fee; or
(D) A hospital that must be included to receive federal approval.
(III) The enterprise may reduce the amount of the hospital provider fee for certain hospitals to obtain federal approval and to minimize the financial impact on certain hospitals. In determining for which hospitals the enterprise may reduce the amount of the hospital provider fee, the enterprise shall use one or more of the following criteria:
(A) The hospital is a type of hospital described in subsection (4)(c)(I) of this section;
(B) The hospital is located in a rural area;
(C) The hospital serves a higher percentage than the average hospital of persons covered by the state medical assistance program, medicare, or commercial insurance or persons enrolled in a managed care organization;
(D) The hospital does not contract with the state department to provide services under the state medical assistance program;
(E) If the hospital paid a reduced hospital provider fee, the reduced fee would not significantly affect the net benefit to hospitals paying the fee; or
(F) The hospital is required not to pay a reduced hospital provider fee as a condition of federal approval.
(IV) The enterprise may change how it pays hospital reimbursement or quality incentive payments, or both, in whole or in part, under the authority of a federal waiver if the total reimbursement to hospitals is equal to or above the federal upper payment limit calculation under the waiver.
(d) The enterprise may alter the process prescribed in this subsection (4) to the extent necessary to meet the federal requirements and to obtain federal approval.
(e) (I) The enterprise shall establish policies on the calculation, assessment, and timing of the hospital provider fee. The enterprise shall assess the hospital provider fee on a schedule to be set by the enterprise board as provided in subsection (7)(d) of this section. The periodic hospital provider fee payments from a hospital and the enterprise's reimbursement to the hospital under subsections (5)(b)(I) and (5)(b)(II) of this section are due as nearly simultaneously as feasible; except that the enterprise's reimbursement to the hospital is due no more than two days after the periodic hospital provider fee payment is received from the hospital. The hospital provider fee must be imposed on each hospital even if more than one hospital is owned by the same entity. The fee must be prorated and adjusted for the expected volume of service for any year in which a hospital opens or closes.
(II) The enterprise is authorized to refund any unused portion of the hospital provider fee. For any portion of the hospital provider fee that has been collected by the enterprise but for which the enterprise has not received federal matching funds, the enterprise shall refund back to the hospital that paid the fee the amount of that portion of the fee within five business days after the fee is collected.
(III) The enterprise shall establish requirements for the reports that hospitals must submit to the enterprise to allow the enterprise to calculate the amount of the hospital provider fee. Notwithstanding the provisions of part 2 of article 72 of title 24 or subsection (7)(f) of this section, information provided to the enterprise pursuant to this section is confidential and is not a public record. Nonetheless, the enterprise may prepare and release summaries of the reports to the public.
(f) A hospital shall not include any amount of the hospital provider fee as a separate line item in its billing statements.
(g) (I) The state board shall promulgate any rules pursuant to the State Administrative Procedure Act, article 4 of title 24, necessary for the administration and implementation of this section. Prior to submitting any proposed rules concerning the administration or implementation of the hospital provider fee to the state board, the enterprise shall consult with the state board on the proposed rules as specified in subsection (7)(d) of this section.
(II) No later than July 1, 2025, the state board, in consultation with the enterprise, shall promulgate rules concerning the policy for qualification for disproportionate share hospital payments. Subject to the requirements under federal law, the disproportionate share hospital payment policy must direct funding to hospitals serving a greater proportion of medicaid and uninsured patients compared to other hospitals and offering financial assistance to lower-income Coloradans.
(4.5) Healthcare affordability and sustainability nursing facility provider fee. (a) Beginning on May 1, 2025, the enterprise is authorized to charge and collect a healthcare affordability and sustainability nursing facility provider fee on health-care items or services provided by nursing facility providers for the purpose of obtaining federal financial participation under the state medical assistance program as described in this article 4 and articles 5 and 6 of this title 25.5. The enterprise shall use the nursing facility provider fee revenue to provide a business service to nursing facility providers by sustaining or increasing reimbursement for providing medical care under the state medical assistance program for nursing facility providers and making supplemental medicaid payments to nursing facility providers, as specified by the priority of the uses of the nursing facility provider fee revenue set forth in subsection (5.5)(b) of this section.
(b) The enterprise shall recommend for approval and establishment by the state board the amount of the nursing facility provider fee that it intends to charge and collect. The state board must establish the final amount of the fee by rule. The state board shall not establish any amount that exceeds the federal limit for such fees. The state board may deviate from the recommendations of the enterprise, but shall express in writing the reasons for any deviations. In establishing the amount of the fee and in promulgating the rules governing the fee, the state board shall:
(I) Consider recommendations of the enterprise; and
(II) Establish the amount of the nursing facility provider fee so that the amount collected from the fee and federal matching funds associated with the fee are sufficient to pay for the items described in subsection (4.5)(a) of this section, but nothing in this subsection (4.5)(b)(II) requires the state board to increase the fee above the amount recommended by the enterprise.
(c) The enterprise shall not charge or collect the nursing facility provider fee in the absence of the federal government's approval of a state medicaid plan amendment authorizing federal financial participation for the nursing facility provider fee. The enterprise may alter the process prescribed in this subsection (4.5) to the extent necessary to meet federal requirements and to obtain federal approval. The enterprise may lower the amount of the nursing facility provider fee charged to certain nursing facility providers to meet the requirements of 42 CFR 433.68 (e) and to obtain federal approval.
(d) (I) In accordance with the redistributive method set forth in 42 CFR 433.68 (e)(1) and (e)(2), the enterprise, acting in concert with or through an agreement with the state department if required by federal law, may seek a waiver from the broad-based nursing facility provider fee requirement or the uniform nursing facility provider fee requirement, or both.
(II) Subject to federal approval and to minimize the financial impact on certain nursing facility providers, the enterprise may exempt from payment of the nursing facility provider fee certain types of nursing provider facilities, including but not limited to:
(A) A facility operated as a continuing care retirement community that provides a continuum of services by one operational entity providing independent living services, assisted living services, and skilled nursing care on a single, contiguous campus. Assisted living services include an assisted living residence as defined in section 25-27-102 or a facility that provides assisted living services on-site, twenty-four hours per day, seven days per week.
(B) A skilled nursing facility owned and operated by the state;
(C) A nursing facility that is a distinct part of a facility that is licensed as a general acute care hospital; and
(D) A facility that has forty-five or fewer licensed beds.
(e) (I) The enterprise shall establish policies on the calculation, assessment, and timing of the nursing facility provider fee. The enterprise shall assess the nursing facility provider fee on a monthly basis. The nursing facility provider fee payments from a nursing facility provider and the enterprise's reimbursement and supplemental payments to the nursing facility provider under subsection (5.5)(b) of this section are due as nearly simultaneously as feasible; except that the enterprise's reimbursement and supplemental payments to the nursing facility provider are due no more than fifteen days after the nursing facility provider fee payment is received from the nursing facility provider.
(II) The enterprise shall establish requirements for the reports that nursing facility providers must submit to the enterprise to allow the enterprise to calculate the amount of the nursing facility provider fee, including a requirement that each nursing facility provider report annually its total number of days of care provided to nonmedicare residents. Notwithstanding part 2 of article 72 of title 24 or subsection (7)(f) of this section, information provided to the enterprise pursuant to this subsection (4.5)(e)(II) is confidential and is not a public record. Nonetheless, the enterprise may prepare and release summaries of the reports to the public.
(f) A nursing facility provider shall not include any amount of the nursing facility provider fee as a separate line item in its billing statements.
(g) The state board shall adopt any rules pursuant to the State Administrative Procedure Act, article 4 of title 24, necessary for the administration and implementation of this section. Prior to submitting any proposed rules concerning the administration or implementation of the nursing facility provider fee to the state board, the enterprise shall consult with the state board on the proposed rules as specified in subsection (7)(h) of this section.
(4.7) Healthcare affordability and sustainability intermediate care facility fee. (a) Beginning on May 1, 2025, the enterprise is authorized to charge and collect a healthcare affordability and sustainability intermediate care facility fee on both privately owned and state-operated intermediate care facilities for individuals with intellectual disabilities for the purpose of maintaining the quality and continuity of services provided by intermediate care facilities for individuals with intellectual disabilities. The enterprise shall use the intermediate care facility fee revenue to provide a business service to such intermediate care facilities by sustaining or increasing reimbursement to such facilities, as specified in subsection (5.7)(b) of this section.
(b) The enterprise shall recommend for approval and establishment by the state board the amount of the intermediate care facility fee that it intends to charge and collect, which must not exceed five percent of the total costs incurred by all intermediate care facilities for the fiscal year in which the fee is charged. The state board must establish the final amount of the fee by rule. The state board shall not establish any amount that exceeds the federal limit for such fees. The state board may deviate from the recommendations of the enterprise, but shall express in writing the reasons for any deviations.
(c) The enterprise may alter the process prescribed in this subsection (4.7) to the extent necessary to meet federal requirements.
(d) (I) The enterprise shall establish policies on the calculation, assessment, and timing of the intermediate care facility fee.
(II) The enterprise shall establish requirements for the reports that intermediate care facilities must submit to the enterprise to allow the enterprise to calculate the amount of the intermediate care facility fee. Notwithstanding part 2 of article 72 of title 24 or subsection (7)(f) of this section, information provided to the enterprise pursuant to this subsection (4.7)(d)(II) is confidential and is not a public record. Nonetheless, the enterprise may prepare and release summaries of the reports to the public.
(e) The state board shall adopt any rules pursuant to the State Administrative Procedure Act, article 4 of title 24, necessary for the administration and implementation of this section. Prior to submitting any proposed rules concerning the administration or implementation of the intermediate care facility fee to the state board, the enterprise shall consult with the state board on the proposed rules as specified in subsection (7)(h) of this section.
(5) Healthcare affordability and sustainability hospital provider fee cash fund. (a) (I) Any healthcare affordability and sustainability hospital provider fee collected or public funds received pursuant to this section by the enterprise must be transmitted to the state treasurer, who shall credit the fee or public funds to the healthcare affordability and sustainability hospital provider fee cash fund, which fund is created. The state treasurer shall credit all interest and income derived from the deposit and investment of money in the hospital provider fee cash fund to the fund. The state treasurer shall invest any money in the hospital provider fee cash fund not expended for the purposes specified in subsection (5)(b) of this section as provided by law. Money in the hospital provider fee cash fund shall not be transferred to any other fund and shall not be used for any purpose other than the purposes specified in this subsection (5) and in subsection (4) of this section.
(II) (A) The fund created in this subsection (5)(a) was renamed as the healthcare affordability and sustainability hospital provider fee cash fund in Senate Bill 25-270, enacted in 2025. For purposes of the annual general appropriation acts for the 2024-25 and 2025-26 state fiscal years, the cash funds appropriations made to the department of health care policy and financing from the healthcare affordability and sustainability fee cash fund, as the fund was named prior to the enactment of Senate Bill 25-270, enacted in 2025, are from the healthcare affordability and sustainability hospital provider fee cash fund, as renamed by Senate Bill 25-270, enacted in 2025.
(B) This subsection (5)(a)(II) is repealed, effective July 1, 2027.
(b) All money in the hospital provider fee cash fund is subject to federal matching as authorized under federal law and, subject to annual appropriation by the general assembly, shall be expended by the enterprise for the following purposes:
(I) To maximize the inpatient and outpatient hospital reimbursements to up to the upper payment limits as defined in 42 CFR 447.272 and 42 CFR 447.321;
(I.5) To maximize the inpatient and outpatient hospital reimbursements, as permitted in 42 CFR 438.6(c);
(II) To increase hospital reimbursements through disproportionate share hospital payments to up to one hundred percent of the hospital's hospital-specific disproportionate share hospital limit;
(III) To pay the quality incentive payments provided in section 25.5-4-402 (3);
(IV) Subject to available revenue from the hospital provider fee and federal matching funds, to expand eligibility for public medical assistance by:
(A) Increasing the eligibility level for parents and caretaker relatives of children who are eligible for medical assistance, pursuant to section 25.5-5-201 (1)(m), from sixty-one percent to one hundred thirty-three percent of the federal poverty line;
(B) Increasing the eligibility level for children and pregnant women under the children's basic health plan to up to two hundred sixty percent of the federal poverty line;
(C) Providing eligibility under the state medical assistance program for a childless adult or an adult without a dependent child in the home, pursuant to section 25.5-5-201 (1)(p), who earns up to one hundred thirty-three percent of the federal poverty line; and
(D) Providing a buy-in program in the state medical assistance program for disabled adults and children whose families have income of up to four hundred fifty percent of the federal poverty line;
(V) To provide continuous eligibility for twelve months for children enrolled in the state medical assistance program;
(VI) To pay the enterprise's actual administrative costs of implementing and administering this section, including but not limited to the following costs:
(A) Administrative expenses of the enterprise;
(B) The enterprise's actual costs related to implementing and maintaining the hospital provider fee and receipt of public funds, including personal services, operating, and consulting expenses;
(C) The enterprise's actual costs for the changes and updates to the medicaid management information system for the implementation of subsections (5)(b)(I) to (5)(b)(III) of this section;
(D) The enterprise's personal services and operating costs related to personnel, consulting services, and for review of hospital costs necessary to implement and administer the increases in inpatient and outpatient hospital payments made pursuant to subsections (5)(b)(I) and (5)(b)(I.5) of this section, disproportionate share hospital payments made pursuant to subsection (5)(b)(II) of this section, and quality incentive payments made pursuant to subsection (5)(b)(III) of this section;
(E) The enterprise's actual costs for the changes and updates to the Colorado benefits management system and medicaid management information system to implement and maintain the expanded eligibility provided for in subsections (5)(b)(IV) and (5)(b)(V) of this section;
(F) The enterprise's personal services and operating costs related to personnel necessary to implement and administer the expanded eligibility for public medical assistance provided for in subsections (5)(b)(IV) and (5)(b)(V) of this section, including but not limited to administrative costs associated with the determination of eligibility for public medical assistance by county departments; and
(G) The enterprise's personal services, operating, and systems costs related to expanding the opportunity for individuals to apply for public medical assistance directly at hospitals or through another entity outside the county departments, in connection with section 25.5-4-205, that would increase access to public medical assistance and reduce the number of uninsured served by hospitals;
(VII) To offset the loss of any federal matching money due to a decrease in the certification of the public expenditure process for outpatient hospital services for medical services premiums that were in effect as of July 1, 2008;
(VIII) Subject to any necessary federal waivers being obtained, to provide funding for a health-care delivery system reform incentive payments program as described in subsection (8) of this section;
(VIII.3) to (VIII.7) Repealed.
(IX) To provide additional business services to hospitals as specified in subsection (4)(a)(IV) of this section.
(c) Repealed.
(5.1) Healthcare affordability and sustainability medicaid buy-in cash fund. (a) The healthcare affordability and sustainability medicaid buy-in cash fund, referred to in this section as the buy-in fund, is created in the state treasury. The buy-in fund consists of the premiums credited to the buy-in fund pursuant to sections 25.5-5-206 and 25.5-6-1404 and any other money that the general assembly may appropriate or transfer to the buy-in fund. Money in the buy-in fund shall not be transferred to any other fund and shall not be used for any purpose other than the purposes specified in this subsection (5.1).
(b) The state treasurer shall credit all interest and income derived from the deposit and investment of money in the buy-in fund to the buy-in fund.
(c) Subject to annual appropriation by the general assembly, the enterprise may expend money from the buy-in fund for the purpose of providing the medicaid buy-in programs created pursuant to part 14 of article 6 of this title 25.5 and section 25.5-5-206.
(5.5) Healthcare affordability and sustainability nursing facility provider fee cash fund. (a) All healthcare affordability and sustainability nursing provider fees collected pursuant to this section by the enterprise must be transmitted to the state treasurer, who shall credit the fee to the healthcare affordability and sustainability nursing facility provider fee cash fund, which fund is created. The state treasurer shall credit all interest and income derived from the deposit and investment of money in the nursing facility provider fee cash fund to the nursing facility provider fee cash fund. The state treasurer shall invest any money in the nursing facility provider fee cash fund not expended for the purposes specified in subsections (4.5)(a) and (5.5)(b) of this section as provided by law. Money in the nursing facility provider fee cash fund shall not be transferred to any other fund and shall not be used for any purpose other than the purposes specified in this subsection (5.5) and in subsection (4.5)(a) of this section.
(b) All money in the nursing facility provider fee cash fund is subject to federal matching as authorized under federal law and, subject to annual appropriation by the general assembly, must be expended by the enterprise for the following purposes:
(I) (A) To pay the administrative costs of implementing this subsection (5.5) and subsection (4.5) of this section;
(B) To satisfy settlements or judgments resulting from nursing facility provider reimbursement appeals; and
(C) To pay a nursing facility provider a supplemental medicaid payment for care and services rendered to medicaid residents to offset payment of the nursing facility provider fee. The enterprise, in consultation with the state department, shall compute this payment annually, beginning on May 1, 2025, and each July 1 thereafter.
(II) After the payment of the amounts described in subsection (5.5)(b)(I) of this section, to pay the supplemental medicaid payments for acuity or case-mix of residents established under section 25.5-6-202 (2), prior to its repeal on July 1, 2026, or as provided in the rules adopted by the state board pursuant to section 25.5-6-202 (10) and (14)(a), in consultation with the enterprise as provided in subsection (7)(h)(IV) of this section;
(III) After the payment of the amounts described in subsections (5.5)(b)(I) and (5.5)(b)(II) of this section, to pay supplemental medicaid payments based upon performance to those nursing facility providers that provide services that result in better care and higher quality of life for their residents. The enterprise, in consultation with the state board, shall determine the payment amount based upon performance measures established in rules adopted by the state board in the domains of quality of life, quality of care, and facility management. During each state fiscal year, the enterprise may discontinue the supplemental medicaid payment established pursuant to this subsection (5.5)(b)(III) to any nursing facility provider that fails to comply with the established performance measures during the state fiscal year, and the enterprise may initiate the supplemental medicaid payment established pursuant to this subsection (5.5)(b)(III) to any nursing facility provider that comes into compliance with the established performance measures during the state fiscal year.
(IV) (A) After the payment of the amounts described in subsections (5.5)(b)(I) to (5.5)(b)(III) of this section, to pay the supplemental medicaid payments to nursing facility providers that serve residents who have moderate to very severe mental health conditions, dementia diseases and related disabilities, or acquired brain injury. The enterprise, in consultation with the state department, shall compute this payment annually, beginning on May 1, 2025, and each July 1 thereafter.
(B) If the enterprise determines, in consultation with the state department, that the case-mix reimbursement described in subsection (5.5)(b)(II) of this section includes a factor for nursing facility providers that serve residents with severe dementia diseases and related disabilities or acquired brain injury, the enterprise may eliminate this supplemental medicaid payment to those nursing facility providers that serve residents with severe dementia diseases and related disabilities or acquired brain injury.
(V) After the payment of the amounts described in subsections (5.5)(b)(I) to (5.5)(b)(IV) of this section, to pay the supplemental medicaid payments for the amount of the aggregate statewide average per diem rate of patient payment established under section 25.5-6-202 (9), prior to its repeal on July 1, 2026, or as provided in the rules adopted by the state board pursuant to section 25.5-6-202 (10) and (14)(a), in consultation with the enterprise as provided in subsection (7)(h)(IV) of this section.
(5.7) Healthcare affordability and sustainability intermediate care facility fee cash fund. (a) All healthcare affordability and sustainability intermediate care facility fees collected pursuant to this section by the enterprise must be transmitted to the state treasurer, who shall credit the fee to the healthcare affordability and sustainability intermediate care facility fee cash fund, which fund is created. The state treasurer shall credit all interest and income derived from the deposit and investment of money in the intermediate care facility fee cash fund to the intermediate care facility cash fund. The state treasurer shall invest any money in the intermediate care facility fee cash fund not expended for the purposes specified in subsections (4.7)(a) and (5.7)(b) of this section as provided by law. Money in the intermediate care facility fee cash fund shall not be transferred to any other fund and shall not be used for any purpose other than the purposes specified in this subsection (5.7) and in subsection (4.7)(a) of this section.
(b) All money in the intermediate care facility fee cash fund is subject to federal matching as authorized under federal law and, subject to annual appropriation by the general assembly, must be expended by the enterprise for the following purposes:
(I) To pay the administrative costs of implementing this subsection (5.7) and subsection (4.7) of this section; and
(II) To supplement reimbursements to intermediate care facilities for individuals with intellectual disabilities as provided in section 25.5-6-204. The enterprise, in consultation with the state department, shall compute this payment annually, beginning on May 1, 2025, and each July 1 thereafter.
(6) Appropriations. (a) (I) Except as otherwise provided in subsection (6)(b)(I.5) or (6)(b)(I.7) of this section, the hospital provider fee and public funds are to supplement, not supplant, general fund appropriations to support hospital reimbursements. General fund appropriations for hospital reimbursements shall be maintained at the level of appropriations in the medical services premium line item made for the fiscal year commencing July 1, 2008; except that general fund appropriations for hospital reimbursements may be reduced if an index of appropriations to other providers shows that general fund appropriations are reduced for other providers. If the index shows that general fund appropriations are reduced for other providers, the general fund appropriations for hospital reimbursements shall not be reduced by a greater percentage than the reductions of appropriations for the other providers as shown by the index.
(II) If general fund appropriations for hospital reimbursements are reduced below the level of appropriations in the medical services premium line item made for the fiscal year commencing July 1, 2008, the general fund appropriations will be increased back to the level of appropriations in the medical services premium line item made for the fiscal year commencing July 1, 2008, at the same percentage as the appropriations for other providers as shown by the index. The general assembly is not obligated to increase the general fund appropriations back to the level of appropriations in the medical services premium line item in a single fiscal year, and such increases may occur over nonconsecutive fiscal years.
(III) For purposes of this subsection (6)(a), the index of appropriations to other providers or index means the average percent change in reimbursement rates through appropriations or legislation enacted by the general assembly to home health providers, physician services, and outpatient pharmacies, excluding dispensing fees. The state board, after consultation with the enterprise board, is authorized to clarify this definition as necessary by rule.
(IV) Except as otherwise provided in subsection (5.5)(b)(V) of this section, the nursing facility provider fee is to supplement, not supplant, general fund appropriations to support nursing facility provider reimbursements.
(V) Except as otherwise provided in subsection (5.7)(b)(II) of this section, the intermediate care facility fee is to supplement, not supplant, general fund appropriations to support intermediate care facility reimbursements.
(b) If the revenue from the hospital provider fee is insufficient to fully fund all of the purposes described in subsection (5)(b) of this section:
(I) The general assembly is not obligated to appropriate general fund revenues to fund such purposes;
(I.3) to (I.7) Repealed.
(II) The hospital provider reimbursement and quality incentive payment increases described in subsections (5)(b)(I), (5)(b)(II), and (5)(b)(III) of this section and the costs described in subsection (5)(b)(VI) of this section shall be fully funded using revenue from the hospital provider fee and federal matching funds before any eligibility expansion is funded; and
(III) (A) If the state board promulgates rules that expand eligibility for medical assistance to be paid for pursuant to subsection (5)(b)(IV) of this section, and the state department thereafter notifies the enterprise board that the revenue available from the hospital provider fee and the federal matching funds will not be sufficient to pay for all or part of the expanded eligibility, the enterprise board shall recommend to the state board reductions in medical benefits or eligibility so that the revenue will be sufficient to pay for all of the reduced benefits or eligibility. After receiving the recommendations of the enterprise board, the state board shall adopt rules providing for reduced benefits or reduced eligibility for which the revenue will be sufficient and shall forward any adopted rules to the joint budget committee. Notwithstanding the provisions of section 24-4-103 (8) and (12), following the adoption of rules pursuant to this subsection (6)(b)(III)(A), the state board shall not submit the rules to the attorney general and shall not file the rules with the secretary of state until the joint budget committee approves the rules pursuant to subsection (6)(b)(III)(B) of this section.
(B) The joint budget committee shall promptly consider any rules adopted by the state board pursuant to subsection (6)(b)(III)(A) of this section. The joint budget committee shall promptly notify the state department, the state board, and the enterprise board of any action on the rules. If the joint budget committee does not approve the rules, the joint budget committee shall recommend a reduction in benefits or eligibility so that the revenue from the hospital provider fee and the matching federal funds will be sufficient to pay for the reduced benefits or eligibility. After approving the rules pursuant to this subsection (6)(b)(III)(B), the joint budget committee shall request that the committee on legal services, created pursuant to section 2-3-501, extend the rules as provided for in section 24-4-103 (8) unless the committee on legal services finds after review that the rules do not conform with section 24-4-103 (8)(a).
(C) After the state board has received notification of the approval of rules adopted pursuant to subsection (6)(b)(III)(A) of this section, the state board shall submit the rules to the attorney general pursuant to section 24-4-103 (8)(b) and shall file the rules and the opinion of the attorney general with the secretary of state pursuant to section 24-4-103 (12) and with the office of legislative legal services. Pursuant to section 24-4-103 (5), the rules are effective twenty days after publication of the rules and are only effective until the following May 15 unless the rules are extended pursuant to a bill enacted pursuant to section 24-4-103 (8).
(b.5) If the revenue from the nursing facility provider fee is insufficient to fully fund all of the purposes described in subsection (5.5)(b) of this section:
(I) The general assembly is not obligated to appropriate general fund revenues to fund such purposes; and
(II) Subject to the priority of the uses for the nursing facility provider fee as provided in subsection (5.5)(b) of this section, the enterprise, in consultation with the state department, may suspend or reduce any supplemental medicaid payment.
(c) Notwithstanding any other provision of this section, if, after receipt of authorization to receive federal matching funds for money in the hospital provider fee cash fund, the authorization is withdrawn or changed so that federal matching funds are no longer available, the enterprise shall cease collecting the hospital provider fee and receiving public funds and shall repay to the hospitals any money received by the hospital provider fee cash fund that is not subject to federal matching funds.
(c.5) Notwithstanding any other provision of this section, if, after receipt of authorization to receive federal matching funds for money in the nursing facility provider fee cash fund, the authorization is withdrawn or changed so that federal matching funds are no longer available, the enterprise shall cease collecting the nursing facility provider fee and shall repay to the nursing facility providers any money received in the nursing facility provider fee cash fund that is not subject to federal matching funds.
(c.7) Notwithstanding any other provision of this section, if, after receipt of authorization to receive federal matching funds for money in the intermediate care facility fee cash fund, the authorization is withdrawn or changed so that federal matching funds are no longer available, the enterprise shall cease collecting the intermediate care facility fee and shall repay to the intermediate care facilities any money received in the intermediate care facility fee cash fund that is not subject to federal matching funds.
(7) Colorado healthcare affordability and sustainability enterprise board. (a) (I) Except as otherwise provided in subsection (7)(a)(II) of this section, the enterprise board consists of thirteen members appointed by the governor, with the advice and consent of the senate, as follows:
(A) Five members who are employed by hospitals in Colorado, including at least one person who is employed by a hospital in a rural area, one person who is employed by a safety-net hospital for which the percent of medicaid-eligible inpatient days relative to its total inpatient days is equal to or greater than one standard deviation above the mean, and one person who is employed by a hospital in an urban area;
(B) One member who is a representative of a statewide organization of hospitals;
(C) One member who represents a statewide organization of health insurance carriers or a health insurance carrier licensed pursuant to title 10 and who is not a representative of a hospital;
(D) One member of the health-care industry who does not represent a hospital or a health insurance carrier;
(E) One member who is a consumer of health care and who is not a representative or an employee of a hospital, health insurance carrier, or other health-care industry entity;
(F) One member who is a representative of persons with disabilities, who is living with a disability, and who is not a representative or an employee of a hospital, health insurance carrier, or other health-care industry entity;
(G) One member who is a representative of a business that purchases or otherwise provides health insurance for its employees; and
(H) Two employees of the state department.
(II) The initial members of the enterprise board are the members of the hospital provider fee oversight and advisory board that was created and existed pursuant to section 25.5-4-402.3 (6), prior to July 1, 2017, and such members shall serve on and after July 1, 2017, for the remainder of the terms for which they were appointed as members of the advisory board. The powers, duties, and functions of the enterprise board include the powers, duties, and functions of the former hospital provider fee oversight and advisory board, and the hospital provider fee oversight and advisory board is abolished.
(III) The governor shall consult with representatives of a statewide organization of hospitals in making the appointments pursuant to subsections (7)(a)(I)(A) and (7)(a)(I)(B) of this section. No more than six members of the enterprise board may be members of the same political party.
(IV) Members of the enterprise board serve at the pleasure of the governor. All terms are for four years. A member who is appointed to fill a vacancy shall serve the remainder of the unexpired term of the former member.
(V) The governor shall designate a chair from among the members of the enterprise board appointed pursuant to subsections (7)(a)(I)(A) to (7)(a)(I)(G) of this section. The enterprise board shall elect a vice-chair from among its members.
(b) Members of the enterprise board serve without compensation but must be reimbursed from money in the hospital provider fee cash fund for actual and necessary expenses incurred in the performance of their duties pursuant to this section.
(c) The enterprise board may contract for a group facilitator to assist the members of the enterprise board in performing their required duties.
(d) The enterprise board has, at a minimum, the following duties:
(I) To determine the timing and method by which the enterprise assesses the hospital provider fee and the amount of the fee;
(II) If requested by the health and human services committee of the senate or the health and human services committee of the house of representatives, or any successor committees, to consult with the committees on any legislation that may impact the fees, payments, or reimbursements established pursuant to this section;
(III) To determine changes in the hospital provider fee that increase the number of hospitals benefitting from the uses of the fee described in subsections (5)(b)(I) to (5)(b)(IV) of this section or that minimize the number of hospitals that suffer losses as a result of paying the hospital provider fee;
(IV) To recommend to the state department reforms or changes to the inpatient hospital and outpatient hospital reimbursements and quality incentive payments made under the state medical assistance program to increase provider accountability, performance, and reporting;
(V) To direct and oversee the enterprise in seeking, in concert with or through an agreement with the state department if required by federal law, any federal waiver necessary to fund and, in cooperation with the state department and hospitals, support the implementation of a health-care delivery system reform incentive payments program as described in subsection (8) of this section;
(VI) To recommend to the state department the schedule and approach to the implementation of subsections (5)(b)(IV) and (5)(b)(V) of this section;
(VII) If money in the fund is insufficient to fully fund all of the purposes specified in subsection (5)(b) of this section, to recommend to the state board changes to the expanded eligibility provisions described in subsection (5)(b)(IV) of this section;
(VIII) To prepare the reports specified in subsection (7)(e) of this section;
(IX) To monitor the impact of the hospital provider fee, the nursing facility provider fee, and the intermediate care facility fee on the broader health-care marketplace;
(X) To establish requirements for the reports that hospitals must submit to the enterprise to allow the enterprise to calculate the amount of the hospital provider fee; and
(XI) To perform any other duties required to fulfill the enterprise board's charge or those assigned to it by the state board or the executive director.
(e) On or before January 15, 2018, and on or before January 15 each year thereafter, the enterprise board shall submit a written report to the health and human services committee of the senate and the health and human services committee of the house of representatives, or any successor committees, the joint budget committee of the general assembly, the governor, and the state board. The report shall include, but need not be limited to:
(I) The recommendations made to the state board pursuant to this section;
(II) A description of the formula for how the hospital provider fee is calculated and the process by which the fee is assessed and collected;
(II.5) A description of the formula for how the nursing facility provider fee is calculated and the process by which the fee is assessed and collected;
(II.7) A description of the formula for how the intermediate care facility fee is calculated and the process by which the fee is assessed and collected;
(III) An itemization of the total amount of the hospital provider fee paid by each hospital and any projected revenue that each hospital is expected to receive due to:
(A) The increased reimbursements made pursuant to subsections (5)(b)(I) and (5)(b)(II) of this section and the quality incentive payments made pursuant to subsection (5)(b)(III) of this section; and
(B) The increased eligibility described in subsections (5)(b)(IV) and (5)(b)(V) of this section;
(III.5) An itemization of the total amount of the nursing facility provider fee paid by each nursing facility provider and any projected revenue that each nursing facility provider is expected to receive due to increased reimbursements and supplemental payments made pursuant to subsection (5.5)(b) of this section;
(III.7) An itemization of the total amount of the intermediate care facility fee paid by each intermediate care facility for individuals with intellectual disabilities and any projected revenue that each intermediate care facility is expected to receive due to increased reimbursements made pursuant to subsection (5.7)(b) of this section;
(IV) An itemization of the costs incurred by the enterprise in implementing and administering the hospital provider fee, the nursing facility provider fee, and the intermediate care facility fee;
(V) Estimates of the differences between the cost of care provided and the payment received by hospitals on a per-patient basis, aggregated for all hospitals, for patients covered by each of the following:
(A) Medicaid;
(B) Medicare; and
(C) All other payers; and
(VI) A summary of:
(A) The efforts made by the enterprise, acting in concert with or through an agreement with the state department if required by federal law, to seek any federal waiver necessary to fund and, in cooperation with the state department and hospitals, support the implementation of a health-care delivery system reform incentive payments program as described in subsection (8) of this section; and
(B) The progress actually made by the enterprise, in cooperation with the state department and hospitals, towards the goal of implementing such a program.
(e.5) The enterprise board shall calculate the estimates described in subsection (7)(e)(V) of this section by using appropriate information provided to the state department by hospitals and any state department analysis of that information.
(f) (I) The enterprise is subject to the open meetings provisions of the Colorado Sunshine Act of 1972, contained in part 4 of article 6 of title 24, and the Colorado Open Records Act, part 2 of article 72 of title 24.
(II) For purposes of the Colorado Open Records Act, part 2 of article 72 of title 24, and except as may otherwise be provided by federal law or regulation or state law, the records of the enterprise are public records, as defined in section 24-72-202 (6), regardless of whether the enterprise receives less than ten percent of its total annual revenues in grants, as defined in section 24-77-102 (7), from all Colorado state and local governments combined.
(III) The enterprise is a public entity for purposes of part 2 of article 57 of title 11.
(g) (I) The medicaid buy-in enterprise support board is created within the enterprise for the purpose of supporting the enterprise board with the implementation of the medicaid buy-in programs. The medicaid buy-in enterprise support board consists of five members appointed by the governor, with the advice and consent of the senate, as follows:
(A) One member who is a representative of persons with disabilities, who is living with a disability;
(B) Two members who are representatives of a disability rights organization or a disabled persons consumer advocacy organization;
(C) One employee of the state department; and
(D) One employee of the department of labor and employment created in section 24-1-121.
(II) (A) Members of the medicaid buy-in enterprise support board serve at the pleasure of the governor. All terms are for four years. A member who is appointed to fill a vacancy shall serve the remainder of the unexpired term of the former member.
(B) The governor shall make the initial appointments to the medicaid buy-in enterprise support board as soon as practical following May 1, 2025.
(III) The medicaid buy-in enterprise support board shall elect a chair and a vice-chair from among its members.
(IV) On behalf of the enterprise, the medicaid buy-in enterprise support board shall consult with the state department and the state board on the amount of the premiums for and other components of the medicaid buy-in programs created pursuant to part 14 of article 6 of this title 25.5 and section 25.5-5-206.
(V) Members of the medicaid buy-in enterprise support board serve without compensation but must be reimbursed from money in the buy-in fund for actual and necessary expenses incurred in the performance of their duties pursuant to this section.
(h) (I) The facility provider fee enterprise support board is created within the enterprise for the purpose of supporting the enterprise board with the implementation of the nursing facility provider fee and the intermediate care facility fee. The facility provider fee enterprise support board consists of eight members appointed by the governor, with the advice and consent of the senate, as follows:
(A) Two members who are representatives of nursing facility associations;
(B) Two members who are representatives of nursing facilities, with one member representing a rural nursing facility;
(C) One member who is a resident of a long-term care facility or a consumer of long-term care services, or a family member or guardian representing such resident or consumer;
(D) One employee of the state department;
(E) One employee of the department of human services created in section 24-1-120; and
(F) One employee of the department of public health and environment created in section 25-1-102.
(II) (A) Members of the facility provider fee enterprise support board serve at the pleasure of the governor. All terms are for four years. A member who is appointed to fill a vacancy shall serve the remainder of the unexpired term of the former member.
(B) The governor shall make the initial appointments to the facility provider fee enterprise support board as soon as practical following May 1, 2025.
(III) The facility provider fee enterprise support board shall elect a chair and a vice-chair from among its members.
(IV) The facility provider fee enterprise support board shall fulfill, at a minimum, the following duties on behalf of the enterprise:
(A) To determine the timing and method by which the enterprise assesses the nursing facility provider fee and the intermediate care facility fee and the amounts of the fees;
(B) To determine changes in the nursing facility provider fee that increase the number of nursing facility providers benefitting from the uses of the fee described in subsection (5.5)(b) of this section or that minimize the number of nursing facility providers that suffer losses as a result of paying the nursing facility provider fee;
(C) To determine changes in the intermediate care facility fee that increase the number of intermediate care facilities for individuals with intellectual disabilities that benefit from the uses of the fee described in subsection (5.7)(b) of this section or that minimize the number of intermediate care facilities for individuals with intellectual disabilities that suffer losses as a result of paying the nursing facility provider fee;
(D) To consult with the state board on the rules regarding payments to nursing facility providers that it adopts pursuant to section 25.5-6-202 (10) and (14)(a);
(E) To consult with the state board and the state department on the rules, price schedules, and allowances regarding reimbursement and payments to intermediate care facilities that they adopt pursuant to section 25.5-6-204;
(F) To establish requirements for the reports that nursing facility providers must submit to the enterprise to allow the enterprise to calculate the amount of the nursing facility provider fee; and
(G) To establish requirements for the reports that intermediate care facilities must submit to the enterprise to allow the enterprise to calculate the amount of the intermediate care facility fee.
(V) Members of the facility provider fee enterprise support board serve without compensation but must be reimbursed from money in the nursing facility provider fee cash fund or the intermediate care facility fee cash fund for actual and necessary expenses incurred in the performance of their duties pursuant to this section.
(7.5) Enterprise transparency and reporting. To ensure transparency and accountability, and in addition to the report required by subsection (7)(e) of this section, the enterprise shall:
(a) No later than November 1, 2025, and by November 1 of each three-year period thereafter, publish and post on its website a three-year plan that details how the enterprise will execute its business purposes during the current state fiscal year and the two subsequent state fiscal years and that estimates the amount of funding needed to implement the plan; and
(b) Create, maintain, and regularly update on its website a public accountability dashboard that provides, at a minimum, accessible and transparent summary information regarding the implementation of its three-year plan, the funding status and progress toward completion of each project that it wholly or partly funds, and its per-project and total funding and expenditures.
(8) Health-care delivery system reform incentive payments program - funding and implementation. The enterprise, acting in concert with or through an agreement with the state department if required by federal law, shall seek any federal waiver necessary to fund and, in cooperation with the state department and hospitals, support the implementation, no earlier than October 1, 2019, of a health-care delivery system reform incentive payments program that will improve health-care access and outcomes for individuals served by the state department while efficiently utilizing available financial resources. Such a program must, at a minimum:
(a) Include an initial planning phase to:
(I) Assess needs; and
(II) Develop achievable outcome-based metrics to be used to measure progress towards program goals, including the goals of health-care delivery system integration, improved patient outcomes, and more efficient provision of care; and
(b) Address the following focus areas:
(I) Care coordination and care transition management;
(II) Integration of physical and behavioral health-care services;
(III) Chronic condition management;
(IV) Targeted population health; and
(V) Data-driven accountability and outcome measurement.
(9) Definitions. As used in this section, unless the context otherwise requires:
(a) Case-mix has the same meaning as set forth in section 25.5-6-201 (8).
(b) Case-mix reimbursement has the same meaning as set forth in section 25.5-6-201 (12).
(c) Colorado healthcare affordability and sustainability enterprise or enterprise means the enterprise created in subsection (3) of this section.
(d) Facility provider fee enterprise support board means the facility provider fee enterprise support board created in subsection (7)(h) of this section.
(e) Healthcare affordability and sustainability hospital provider fee or hospital provider fee means the healthcare affordability and sustainability hospital provider fee charged and collected as authorized by subsection (4) of this section.
(f) Healthcare affordability and sustainability hospital provider fee cash fund or hospital provider fee cash fund means the healthcare affordability and sustainability hospital provider fee cash fund created in subsection (5) of this section.
(g) Healthcare affordability and sustainability intermediate care facility fee or intermediate care facility fee means the healthcare affordability and sustainability intermediate care facility fee for intermediate care facilities for individuals with intellectual disabilities charged and collected as authorized by subsection (4.7) of this section.
(h) Healthcare affordability and sustainability intermediate care facility fee cash fund or intermediate care facility fee cash fund means the healthcare affordability and sustainability intermediate care facility fee cash fund created in subsection (5.7) of this section.
(i) Healthcare affordability and sustainability nursing facility provider fee or nursing facility provider fee means the healthcare affordability and sustainability nursing facility provider fee charged and collected as authorized by subsection (4.5) of this section.
(j) Healthcare affordability and sustainability nursing facility provider fee cash fund or nursing facility provider fee cash fund means the healthcare affordability and sustainability nursing facility provider fee cash fund created in subsection (5.5) of this section.
(k) Hospital means a licensed or certified hospital.
(l) Nursing facility provider has the same meaning as set forth in section 25.5-6-201 (25).
(m) State medical assistance program means the program described in this article 4 and articles 5 and 6 of this title 25.5.
(n) Statewide average per diem rate has the same meaning as set forth in section 25.5-6-201 (35).
(o) Supplemental medicaid payment has the same meaning as set forth in section 25.5-6-201 (36).
(10) State-directed payments program - funding and implementation. The enterprise, acting in concert with, or through an agreement with, the state department, if required by federal law, shall seek a state plan amendment or any federal authorization necessary to fund and, in cooperation with the state department and hospitals, support the implementation of a state-directed payment program in compliance with 42 CFR 438.6(c) that complies with all federal requirements for financing of the non-federal share and shall support a total payment rate for each state-directed payment that does not exceed the average commercial rate and is distributed pursuant to the requirements of subsection (5) of this section.
Source: L. 2017: Entire section added, (SB 17-267), ch. 267, p. 1448, � 17, effective July 1. L. 2018: IP(5)(b) amended, (SB 18-195), ch. 173, p. 1205, � 1, effective July 1. L. 2019: (7)(e.5) added, (HB 19-1001), ch. 52, p. 177, � 1, effective August 2. L. 2020: (5)(b)(VIII) and (6)(a)(I) amended and (4)(a)(II.5), (5)(b)(VIII.5), and (6)(b)(I.3) added, (HB 20-1361), ch. 161, p. 756, � 2, effective June 29; (5)(b)(VIII) and (6)(a)(I) amended and (4)(a)(II.3), (5)(b)(VIII.3), and (6)(b)(I.5) added, (HB 20-1385), ch. 173, p. 795, � 2, effective June 29; IP(4)(a), (5)(b)(VIII), and (6)(a)(I) amended and (4)(a)(II.5), (5)(b)(VIII.7), and (6)(b)(I.7) added, (HB 20-1386), ch. 210, p. 1023, � 1, effective June 30. L. 2021: (4)(a)(II.3), (5)(b)(VIII.3), and (6)(b)(I.5)(B) amended, (SB 21-213), ch. 88, p. 363, � 2, effective May 4; (4)(a)(II.5), (5)(b)(VIII.5), and (6)(b)(I.3) repealed and (6)(a)(I) amended, (SB 21-211), ch. 86, p. 358, � 2, effective May 4; (5)(c) added, (SB 21-286), ch. 395, p. 2626, � 2, effective June 30. L. 2022: (5)(c)(I) amended, (HB 22-1188), ch. 14, p. 124, � 1, effective March 7; (5)(b)(IV)(B) amended, (SB 22-052), ch. 43, p. 216, � 1, effective March 24; (3)(e) and (7)(a)(II) amended, (SB 22-162), ch. 469, p. 3371, � 60; effective August 10. L. 2024: (2)(d)(I), IP(4)(a), (4)(a)(I), (4)(g), (5)(b)(II), and (5)(b)(VI)(D) amended, (HB 24-1399), ch. 76, p. 251, � 7, effective July 1, 2025; (4)(c)(I)(C) amended, (SB 24-121), ch. 439, p. 3067, � 6, effective July 1, 2026. L. 2025: IP(2), (2)(f), (2)(g), (3)(a), (3)(d)(I), and (3)(d)(III) amended and (3)(c)(III), (5.1), and (7)(g) added, (SB 25-228), ch. 150, p. 571, � 1, effective May 1; IP(2), (2)(a), IP(2)(c), (2)(c)(V), (2)(c)(VI), IP(2)(d), (2)(d)(I), (2)(e), (2)(f), (2)(g), (3)(a), (3)(c)(I), (3)(d)(I), (3)(d)(II), (3)(d)(III), (3)(d)(V), IP(4)(a), IP(4)(b), (4)(b)(II), (4)(b)(III), IP(4)(c)(I), (4)(c)(II)(C), IP(4)(c)(III), (4)(c)(III)(E), (4)(c)(III)(F), (4)(e), (4)(f), (4)(g), (4)(g)(I), (5)(a), IP(5)(b), IP(5)(b)(IV), (5)(b)(VI)(B), (5)(c)(I)(A), (5)(c)(II)(C), (5)(c)(III), (5)(c)(V), (6)(a)(I), IP(6)(b), (6)(b)(II), (6)(b)(III)(A), (6)(b)(III)(B), (6)(c), (7)(b), (7)(d)(I), (7)(d)(II), (7)(d)(III), (7)(d)(IX), (7)(d)(X), IP(7)(e), (7)(e)(II), IP(7)(e)(III), and (7)(e)(IV) amended and (2)(c)(V.5), (2)(c)(V.7), (2)(d.5), (2)(d.7), (3)(c)(IV), (3)(c)(V), (4.5), (4.7), (5.5), (5.7), (6)(a)(IV), (6)(a)(V), (6)(b.5), (6)(c.5), (6)(c.7), (7)(e)(II.5), (7)(e)(II.7), (7)(e)(III.5), (7)(e)(III.7), (7)(h), (7.5), and (9) added, (SB 25-270), ch. 151, pp. 577, 597, �� 1, 2, effective May 1; (2)(f), (3)(d)(V), (3)(d)(VI), (3)(d)(VII), IP(4)(a), IP(4)(b), (4)(b)(II), (5)(a), (5)(b)(VI)(B), (5)(b)(VI)(D), (6)(a)(I), (6)(b)(II), and (6)(c) amended and (2)(f.5), (3)(d)(VIII), (5)(b)(I.5), and (10) added, (HB 25-1213), ch. 276, p. 1435, � 4, effective August 6.
Editor's note: (1) Section 34 of chapter 267 (SB 17-267), Session Laws of Colorado 2017, provides that the section of the act adding this section does not take effect if the centers for medicare and medicaid services determine that the amendments do not comply with federal law. For more information, see SB 17-267. (L. 2017, p. 1478.) The executive director of the department of health care policy and financing did not notify the revisor of statutes by June 1, 2017, of such determination; therefore, this section took effect July 1, 2017.
(2) Amendments to subsection (6)(a)(I) by HB 20-1361, HB 20-1385, and HB 20-1386 were harmonized.
(3) Subsection (4)(a)(II.5) was added in HB 20-1361. It was superseded by the addition of subsection (4)(a)(II.5) in HB 20-1386.
(4) Subsection (5)(b)(VIII.7)(B) provided for the repeal of subsection (5)(b)(VIII.7), effective December 31, 2021. (See L. 2020, p. 1023.)
(5) Subsection (6)(b)(I.7)(B) provided for the repeal of subsection (6)(b)(I.7), effective December 31, 2021. (See L. 2020, p. 1023.)
(6) Amendments to subsection (2)(f) by SB 25-228, SB 25-270, and HB 25-1213 were harmonized.
(7) Amendments to subsections (3)(a), (3)(d)(I), and (3)(d)(III) by SB 25-270 and SB 25-228 were harmonized.
(8) Amendments to subsection (4)(b)(II) by HB 25-1213 were harmonized in part with and superseded in part by SB 25-270.
(9) Amendments to subsections (3)(d)(V), IP(4)(a), IP(4)(b), (5)(a), (5)(b)(VI)(B), (6)(a)(I), (6)(b)(II), and (6)(c) by SB 25-270 and HB 25-1213 were harmonized, and, as a result, amendments to subsection (3)(d)(V) by HB 25-1213 were relettered as (3)(d)(V.5).
(10) Subsections (4)(a)(II.3)(B), (5)(b)(VIII.3)(B), and (6)(b)(I.5)(B) provided for the repeal of subsections (4)(a)(II.3), (5)(b)(VIII.3), and (6)(b)(I.5), respectively, effective December 31, 2024. (See L. 2021, p. 363.)
(11) For the amendments to subsection (5)(c) in SB 25-270 in effect from May 1, 2025, to July 1, 2025, see chapter 151, Session Laws of Colorado 2025. (L. 2025, p. 577.)
(12) Subsection (5)(c)(VI) provided for the repeal of subsection (5)(c), effective July 1, 2025. (See L. 2021, p. 2626.)
(13) For the amendments to subsections (2)(d)(I), IP(4)(a), and (4)(g) in SB 25-270 in effect from May 1, 2025, to July 1, 2025, see chapter 151, Session Laws of Colorado 2025. (L. 2025, p. 577.)
Cross references: (1) For the legislative declaration in SB 17-267, see section 1 of chapter 267, Session Laws of Colorado 2017.
(2) For the short title (the Debbie Haskins 'Administrative Organization Act of 1968' Modernization Act) in SB 22-162, see section 1 of chapter 469, Session Laws of Colorado 2022.