(1) The medical assistance program in this state shall include hospice care. Except as otherwise provided in subsection (2) of this section, hospice care shall be provided for a period of up to two hundred ten days in accordance with rules adopted by the state board, which rules shall comply with 42 U.S.C. sec. 1396d, and shall include at least the following requirements:
(a) That a person shall obtain a certified medical prognosis indicating a life expectancy of nine months or less, which certification shall comply with rules adopted by the state board;
(b) That a person shall execute a waiver of other medical benefits available under this article and articles 4 and 6 of this title, which election shall be executed in accordance with rules adopted by the state board;
(c) That the service shall be reasonable and necessary for the palliation or management of the terminal illness and related conditions.
(2) Hospice care may be provided to a person beyond two hundred ten days if such person is recertified by a physician or hospice medical director as terminally ill in accordance with subsection (1) of this section.
(3) (a) Subject to the receipt of any necessary federal authorization, for a person who has executed the waiver described in paragraph (b) of subsection (1) of this section and who is a resident in a class I facility, as defined in section 25.5-6-201 (13), the class I facility shall bill the state department and the state department shall pay the class I facility for the room and board costs of the person.
(b) Subject to the receipt of any necessary federal authorization, the hospice care provided pursuant to this section may include room and board in a hospice inpatient facility licensed pursuant to section 25-3-101, C.R.S. The state department is authorized to establish the reimbursement rate for the costs for room and board at a licensed hospice inpatient facility for patients eligible for the routine level of hospice care.
(c) (I) If required, the state department shall seek the appropriate federal authorization, conditioned on the receipt of gifts, grants, or donations sufficient to provide for the state's administrative costs of preparing and submitting the request, to make the payment described in paragraph (a) of this subsection (3) and to include room and board at a licensed hospice inpatient facility as described in paragraph (b) of this subsection (3). On or before January 15, 2011, the state department shall submit a brief report to the members of the health and human services committees of the senate and house of representatives, or any successor committees, on the status of any request for authorization pursuant to this subparagraph (I). If federal authorization to implement the changes described in paragraphs (a) and (b) of this subsection (3) is obtained, the state department shall request, through the state budget process, that the changes be implemented during the fiscal year following the year in which the approval is obtained.
(II) The state department is authorized to seek and accept gifts, grants, or donations from private or public sources for the purpose of providing for the administrative costs of preparing and submitting the request for federal approval for the payments described in paragraphs (a) and (b) of this subsection (3). All such private and public funds received through gifts, grants, or donations shall be transmitted to the state treasurer, who shall credit the same to the hospice care account in the department of health care policy and financing cash fund created pursuant to section 25.5-1-109, which account is hereby created. Moneys in the account shall be subject to appropriation and shall only be used for the purposes described in this subparagraph (II).
(d) For the provision of pediatric hospice care, the state department shall seek an exemption from the following federal medicaid requirements for the eligibility of and election for hospice care:
(I) The mandatory do-not-resuscitate order;
(II) A physician's certification that a patient is expected to live less than six months; and
(III) The nonallowance of curative care therapies concurrent with palliative and hospice care.
(4) Repealed.
Source: L. 2006: Entire article added with relocations, p. 1868, � 7, effective July 1. L. 2010: IP(1) and (1)(a) amended and (4) added, (HB 10-1027), ch. 274, p. 1256, � 1, effective August 11; (3) added, (SB 10-061), ch. 247, p. 1104, � 1, effective August 11. L. 2025: (3)(d) added, (HB 25-1003), ch. 50, p. 222, � 2, effective July 1.
Editor's note: (1) This section is similar to former � 26-4-520 as it existed prior to 2006.
(2) Subsection (4)(b) provided for the repeal of subsection (4), effective the July 1 following the revisor of statutes' receipt of the required notice. (See L. 2010, p. 1256.) The revisor of statutes received the required notice on May 31, 2012.
25.5-5-305. Pediatric hospice care - legislative declaration - federal authorization - rules - repeal. (1) Legislative declaration. (a) The general assembly finds and declares that:
(I) The death of a child has a devastating and enduring impact on the child's family;
(II) Too often, children with fatal conditions and their families fail to receive compassionate and consistent care that meets their physical, emotional, and spiritual needs;
(III) Better care is possible but current methods of organizing and financing palliative, end-of-life, and bereavement care impede the provision of services that are both more appropriate and more cost-efficient;
(IV) Current federal medicaid regulations contain inherent barriers to providing appropriate palliative and end-of-life care to pediatric patients. These barriers include requirements that preclude the pursuit of curative treatments, mandate a do-not-resuscitate order, and require physician certification that death is expected within six months.
(b) The general assembly declares that it is in the best interest of the state to investigate and implement hospice guidelines that provide appropriate, compassionate care to dying children and their families while proving to be cost-neutral or cost-saving to the state and federal medicaid programs.
(c) The general assembly further finds and declares that, while this direction immediately concerns federal approval for hospice care that recognizes the distinct circumstances of children facing life-threatening illnesses and their families, it is the intent of the general assembly that the information and data produced as a result of this act shall be used to improve the delivery of palliative and end-of-life services to persons of all ages when such improvements can be made in a manner that is cost-neutral or cost-saving to the state.
(2) Definitions. As used in this section, unless the context otherwise requires:
(a) Eligible child means a child who:
(I) Is less than nineteen years of age; and
(II) Is eligible for the state's medicaid program pursuant to section 25.5-5-101, 25.5-5-201, or 25.5-5-203;
(b) Pediatric hospice care means hospice care for eligible children as authorized in this section.
(3) Pediatric hospice care. (a) (I) The state department shall seek the appropriate federal authorization, conditioned on the receipt of gifts, grants, or donations sufficient to provide for the state's administrative costs of preparing and submitting the request, for pediatric hospice care that shall include but may not be limited to:
(A) Respite care;
(B) Expressive therapies, as defined in rule by the state board;
(C) Palliative care from the time of diagnosis of a potentially life-threatening illness; and
(D) A continuum of care through the coordination of services, which may include skilled, intermittent, and around-the-clock nursing care.
(II) The state department is authorized to seek federal approval for modifications to the provision of hospice care for adults who are eligible for the state's medicaid program.
(b) For the provision of pediatric hospice care, the state department shall seek an exemption from the following federal medicaid requirements for the eligibility of and election for hospice care:
(I) The mandatory do-not-resuscitate order;
(II) A physician's certification that a patient is expected to live less than six months; and
(III) The nonallowance of curative care therapies concurrent with palliative and hospice care.
(c) In any application for federal authorization pursuant to this section, the state department shall retain bereavement services to the extent available under federal law.
(d) Pediatric hospice care, as authorized pursuant to this section, shall meet aggregate federal waiver budget neutrality requirements.
(e) The state department shall implement the provision of pediatric hospice care to the extent authorized by the federal government.
(4) Review. The state department shall notify the joint budget committee of the general assembly of the extent to which the state department received federal authorization for pediatric hospice care services pursuant to this section in order for the joint budget committee to review the approved budget neutrality analysis for such services prior to the state department's implementation.
(5) Rules. The state department shall develop the service provisions for pediatric hospice care in consultation with medical professionals who have expertise in providing end-of-life and palliative care to pediatric patients and family members who have experienced the death of a child. The state board shall adopt rules necessary to implement and administer the provisions of this section.
(6) Gifts, grants, and donations. The state department is authorized to seek and accept gifts, grants, or donations from private or public sources for the purpose of providing for the administrative costs of preparing and submitting the request for federal approval for the provision of pediatric hospice care. All private and public funds received through gifts, grants, or donations shall be transmitted to the state treasurer.
(7) Repealed.
(8) This section is repealed, effective July 1, 2026.
Source: L. 2006: Entire article added with relocations, p. 1868, � 7, effective July 1. L. 2025: (7) added, (SB 25-264), ch. 129, p. 506, � 37, effective April 25; (6) amended, (SB 25-264), ch. 129, p. 507, � 38, effective July 1; (8) added by revision, (HB 25-1003), ch. 50, p. 223, �� 6, 7.
Editor's note: (1) This section is similar to former � 26-4-533 as it existed prior to 2006.
(2) For the amendments in SB 25-264 in effect from April 25, 2025, to July 1, 2025, see chapter 129, Session Laws of Colorado 2025. (L. 2025, p. 506.)
(3) Subsection (7)(b) provided for the repeal of subsection (7), effective July 1, 2025. (See L. 2025, p. 506.)
25.5-5-306. Residential child health care - waiver - program - rules - notice to revisor - repeal. (Repealed)
Source: L. 2006: (1) and (3) amended and (4) added, p. 1202, � 2, effective May 26; entire article added with relocations, p. 1871, � 7, effective July 1. L. 2008: (3) amended, p. 1517, � 1, effective May 28. L. 2010: (1) amended, (SB 10-175), ch. 188, p. 801, � 69, effective April 29. L. 2013: (1) amended, (HB 13-1314), ch. 323, p. 1809, � 45, effective March 1, 2014. L. 2016: (1) amended, (SB 16-189), ch. 210, p. 773, � 68, effective June 6. L. 2018: (5) and (6) added, (HB 18-1328), ch. 184, p. 1242, � 2, effective July 1; (1) amended, (SB 18-092), ch. 38, p. 445, � 111, effective August 8. L. 2019: (3) and (4) amended, (HB 19-1172), ch. 136, p. 1708, � 181, effective October 1.
Editor's note: (1) This section was similar to former � 26-4-527 as it existed prior to 2006.
(2) Subsection (6) provided for the repeal of this section, effective June 7, 2019. On August 14, 2019, the revisor of statutes received the notice referred to in subsection (6) related to the repeal. For more information about the repeal and notice, see HB 18-1328. (L. 2018, p. 1242.)
Cross references: (1) For the legislative declaration in SB 18-092, see section 1 of chapter 38, Session Laws of Colorado 2018. For the legislative declaration in HB 18-1328, see section 1 of chapter 184, Session Laws of Colorado 2018.
(2) For current provisions relating to the residential health care program, see � 25.5-6-903.