Source: L. 2006: Entire article added with relocations, p. 1917, � 7, effective July 1. L. 2021: (3) added by revision, (HB 21-1187), ch. 83, pp. 353, 354, �� 69, 70. L. 2024: IP(1), (1)(c)(II), and (2) amended, (SB 24-176), ch. 152, p. 663, � 73, effective August 7.
Editor's note: (1) Prior to its repeal, this section was similar to former � 26-4-525 as it existed prior to 2006.
(2) SB 24-176 amended subsections IP(1), (1)(c)(II), and (2), effective August 7, 2024, but those amendments did not take effect due to the repeal of this section, effective July 1, 2024.
(3) Subsection (3) provided for the repeal of this section, effective July 1, 2024. (See L. 2021, pp. 353, 354.)
25.5-6-108. Legislative declaration - advisory committee - long-term care - report - repeal. (Repealed)
Source: L. 2006: Entire article added with relocations, p. 1917, � 7, effective July 1.
Editor's note: (1) This section was similar to former � 26-4-425 as it existed prior to 2006.
(2) Subsection (9) provided for the repeal of this section, effective July 1, 2007. (See L. 2006, p. 1917.)
25.5-6-108.5. Community long-term care studies - authority to implement - alternative care facility report. (1) (a) Subject to the receipt of sufficient funding pursuant to subsection (1)(c) of this section, the state department shall contract for one or more studies of the population of members receiving services under the home- and community-based waivers authorized pursuant to this article 6. The state department shall make necessary data available to the contractor, including but not limited to data on activities of daily living. In selecting a contractor to perform any study conducted pursuant to this subsection (1), the state department is not required to follow the competitive bidding requirements of the Procurement Code, articles 101 to 112 of title 24. The state department shall provide copies of all studies conducted pursuant to this subsection (1) to members of the health and human services committees of the general assembly, or any successor committees, and to the members of the joint budget committee.
(b) If a study conducted pursuant to this subsection (1) concludes that a program of home- and community-based services would result in cost savings, the state department shall seek any necessary federal authorization to implement the program. If federal authorization to implement the program is obtained, the state department shall request, through the state budget process, that the program be implemented. The state department shall report to the joint budget committee annually concerning the amount of any savings realized from the program.
(c) The state department is authorized to seek and accept gifts, grants, or donations from private and public sources for the purposes of this subsection (1); except that the state department may not accept a gift, grant, or donation that is subject to conditions that are inconsistent with this subsection (1) or any other law of the state. The state department shall transmit all private and public moneys received through gifts, grants, or donations to the state treasurer, who shall credit the same to the department of health care policy and financing cash fund created in section 25.5-1-109.
(2) (a) Subject to the receipt of sufficient funding, one of the studies contracted for pursuant to subsection (1) of this section must include research and analysis of:
(I) The number of members with incontinence, Alzheimer's disease, dementia, or other diagnoses of a chronic incapacitating condition that severely limit the member's activities of daily living who would benefit from receiving additional services through an alternative care facility to avoid nursing home placement;
(II) The actuarially sound rate for providing services for the members at an alternative care facility;
(III) The amount of savings associated with providing services at an alternative care facility;
(IV) Recommendations for utilization controls or program controls for a program to provide services at an alternative care facility;
(V) The experiences of the program of all-inclusive care for the elderly, created pursuant to section 25.5-5-412, with tiered rates for alternative care facilities, including cost savings or cost avoidance;
(VI) Other states' experiences with tiered rates for alternative care facilities, including cost savings or cost avoidance; and
(VII) Recommendations for maintaining or improving quality of care.
(b) The study conducted pursuant to this subsection (2) shall be completed by January 1, 2012, and, if federal approval is obtained prior to final figure-setting for the fiscal year commencing July 1, 2012, the state department shall submit a request through the budget process for implementation of the approved changes for that fiscal year.
Source: L. 2010: Entire section added, (HB 10-1053), ch. 276, p. 1264, � 2, effective May 26. L. 2011: (2)(b) amended, (HB 11-1242), ch. 271, p. 1231, � 2, effective July 1. L. 2024: (1)(a), IP(2)(a), (2)(a)(I), and (2)(a)(II) amended, (SB 24-176), ch. 152, p. 663, � 74, effective August 7.
Cross references: For the legislative declaration in the 2010 act adding this section, see section 1 of chapter 276, Session Laws of Colorado 2010.
25.5-6-109. Community long-term care - coordinated care pilot program - federal authorization - rules - repeal. (Repealed)
Source: L. 2006: Entire article added with relocations, p. 1921, � 7, effective July 1. L. 2007: (1) and (7) amended, p. 2016, � 1, effective June 1. L. 2010: (2)(b) amended, (HB 10-1422), ch. 419, p. 2114, � 149, effective August 11.
Editor's note: (1) This section was similar to former � 26-4-426 as it existed prior to 2006.
(2) Subsection (7) provided for the repeal of this section, effective July 1, 2012. (See L. 2007, p. 2016.)
25.5-6-110. Private-public partnership education and information program concerning long-term care insurance authorized. (1) The general assembly hereby declares that:
(a) A large number of Coloradans are in need of long-term health care;
(b) The cost of long-term care, especially nursing home care, is significant;
(c) Many persons in need of long-term care are ineligible for state medical assistance due to countable resources. When faced with the need for long-term care, such persons expend such resources to pay for nursing home care.
(d) A person's resources may cover only a relatively short period of care, often resulting in rendering such person impoverished, and after which time the person must rely on state medical assistance;
(e) Expenditures for long-term care represent a significant portion of the state's medical assistance budget;
(f) Unless Colorado implements new methods for financing long-term care, which methods include participation by the private sector, the cost to the state for long-term care will increase astronomically; and
(g) It is therefore appropriate to enact legislation that allows the state department, upon a determination by the executive director of the state department that it is feasible, to design and implement a private-public partnership for financing long-term care in this state.
(2) The state department shall cooperate with the division of insurance in the department of regulatory agencies in a private-public partnership for financing long-term care in this state through the availability of long-term care insurance policies that result in a reduction of total dependency on the medical assistance program to finance such care. It is the general assembly's intent that such partnership shall be designed to encourage individuals to purchase long-term care insurance, which, with respect to middle to higher income individuals, will have the result of eliminating or delaying the individual's need for medical assistance.
(3) Under the partnership described in subsection (2) of this section, the division of insurance shall implement statutory changes to article 19 of title 10, C.R.S., concerning long-term care policies that the general assembly hereby declares are necessary to accomplish the purpose of the partnership described in this section. In addition, the state department is encouraged to implement a public education-awareness program based on recommendations from an advisory committee that the executive director of the state department is hereby authorized to establish.
(4) The state department is authorized to seek and accept funds, grants, or donations from any private entity for implementing the public education-awareness program. In addition, if necessary, the state department may assess a fee in connection with conducting any public education-awareness training program or seminar. Any such fee collected shall be transmitted to the state treasurer, who shall credit the same to the long-term care insurance fund, which fund is hereby created. The moneys in the fund shall be subject to annual appropriation by the general assembly for the sole purpose of public education-awareness training programs and seminars.
(5) In addition to administering the public education-awareness program under the partnership, the state department shall seek a federal waiver from the requirement of section 13612 of the federal Omnibus Budget Reconciliation Act of 1993 (OBRA), Public Law 103-66, that prevents the state department from granting medical assistance applicants a full or partial resource exemption in determining eligibility for medical assistance and an exemption from estate recovery requirements.
(6) The state department, if funds are available, shall contract with a public or private entity to conduct an evaluation of the public education-awareness program on or before December 1, 2000.
(7) With respect to a policyholder who has allowed his or her private long-term care insurance policy to lapse, if the person is found to be eligible for the medical assistance program, the state department is authorized to pay the premium for a reinstated policy pursuant to section 10-19-107 (2), C.R.S., if the state department finds that to do so is feasible and cost-efficient.
Source: L. 2006: Entire article added with relocations, p. 1922, � 7, effective July 1.
Editor's note: This section is similar to former � 26-4-506.7 as it existed prior to 2006.
25.5-6-111. Pilot program for coordinated care for people with a disability - fund - repeal. (Repealed)
Source: L. 2006: Entire section added, p. 1115, � 1, effective May 25. L. 2013: (1), (2), (3), (5), (6), and (7) repealed and (4) amended, (SB 13-276), ch. 256, p. 1350, �� 1, 2, effective May 23.
Editor's note: (1) This section was enacted as 26-4-537 in Senate Bill 06-128 but was relocated due to its harmonization with this article as it appeared in Senate Bill 06-219.
(2) Subsection (4)(b) provided for the repeal of subsection (4), effective July 1, 2014. (See L. 2013, p. 1350.)
25.5-6-112. Plan of financial operation - purpose - approval - financial audits - rules - repeal. (Repealed)
Source: L. 2007: Entire section added, p. 1352, � 2, effective May 29. L. 2013: Entire section repealed, (SB 13-276), ch. 256, p. 1353, � 10, effective May 23.
25.5-6-113. Health home - integrated services - contracting - legislative declaration - definitions. (1) (a) The general assembly finds and declares that:
(I) The state demography office in the department of local affairs estimates that between 2005 and 2015, the portion of Colorado's population that is over sixty-five years of age will increase by more than twenty-three percent;
(II) This drastic increase in the population that is over sixty-five years of age is driven by the aging baby boomer generation and will result in a parallel increase in a demand for community long-term care services;
(III) Older adults, persons with disabilities, and their families need quality health-care coverage and choice and flexibility in accessing community long-term care services that support their independence and ability to live in the least restrictive environment;
(IV) Research has shown that older adults suffer from higher rates of depression, have a higher risk of suicide, and have an increased misuse of prescription and illicit drugs, making the need for behavioral health-care services essential to long-term care services;
(V) Coloradans deserve to have access to the proper level of health care;
(VI) The state needs a long-term care delivery system that addresses the needs of older adults, persons with disabilities, and their families, and health-care coverage and coordination should not be fragmented or difficult to access; instead, it should be integrated to meet the needs of older adults, persons with disabilities, and their families;
(VII) A community long-term care system should be integrated, person-centered, and provide maximum service delivery and make efficient use of available public funds; and
(VIII) The system must ensure a comprehensive approach to long-term care that addresses the different demographic and geographic challenges in the state and the various long-term care services and supports that members need.
(b) Therefore, the general assembly declares that a comprehensive approach to long-term care requires that programs and policies integrating and coordinating care under the medicaid program be flexible and allow for full participation by providers of long-term care services to ensure quality of care for members and efficient use of limited resources.
(2) As used in this section, unless the context otherwise requires:
(a) Dually eligible person means a person who is eligible for assistance or benefits under both medicaid and medicare.
(b) Health home means a provider or group of providers that operate in coordination with a team of health-care professionals that shall include primary care providers selected by an eligible individual with chronic conditions to provide health home services, as the term is defined in section 2703 of the federal Patient Protection and Affordable Care Act, 42 U.S.C. sec. 1396w-4.
(3) (a) In determining the structure of health homes for chronic conditions for purposes of the federal Patient Protection and Affordable Care Act, 42 U.S.C. sec. 1396w-4, and state plan amendments to the medicaid program, the state department shall include, to the extent permitted under federal law, provisions allowing providers of long-term care services and supports to participate as health homes or as part of a health home that provides:
(I) Comprehensive care management;
(II) Care coordination and health promotion;
(III) Comprehensive transitional care;
(IV) Patient and family support;
(V) Referral to community and social support services; and
(VI) The use of health information technology to link services, as is feasible and appropriate.
(b) The health home may consist of a multi-disciplinary team, including primary care management providers, behavioral health-care providers, case managers, and providers of long-term services and supports, including, but not limited to, case management agencies, as defined in section 25.5-6-1702, nursing homes, alternative care facilities, day programs for the elderly, home care agencies, comprehensive community behavioral health providers, as defined in section 27-50-101, and hospice and palliative care centers.
(4) To the extent provided under federal law, in integrating dually eligible persons, persons with chronic conditions, or persons needing long-term care services and supports in an organization with which the state department contracts pursuant to part 4 of article 5 of this title, the state department shall permit providers of long-term services and supports to contract as health homes or to provide some or all of the services provided by the organization contracted with the state department, which services may include, but need not be limited to, navigation of primary, specialty, or long-term care supports.
(5) Dually eligible members may voluntarily elect to participate in a recognized medicare coordinated care system and may voluntarily elect to participate in the state department's medicaid coordinated care system.
Source: L. 2012: Entire section added, (SB 12-127), ch. 132, p. 453, � 1, effective April 23. L. 2021: (3)(b) amended, (HB 21-1187), ch. 83, p. 333, � 29, effective July 1, 2024. L. 2024: IP(1)(a), (1)(a)(VIII), (1)(b), and (5) amended, (SB 24-176), ch. 152, p. 664, � 75, effective August 7. L. 2025: (3)(b) amended, (HB 25-1326), ch. 309, p. 1611, � 6, effective August 6.
25.5-6-114. Alternative care facilities - reimbursement programs - legislative declaration - report - repeal. (Repealed)
Source: L. 2012: Entire section added, (SB 12-128), ch. 275, p. 1452, � 1, effective August 8.
Editor's note: Subsection (5) provided for the repeal of this section, effective July 1, 2015. (See L. 2012, p. 1452.)