Updates to Medicaid

Section 4 was modified to change which subsections of C.R.S. 25.5-4-402.4 are being amended, removing (3)(d)(VI) and (3)(d)(VII) and adding (3)(d)(I) to the list of changes.

Senate sponsorship credits were updated to reflect amendments adopted on second reading rather than third reading.

Formatting changes were made to the header indicating the bill status from 'Rerevised' to 'Revised' and adjusting the date reference.

Added a new definition of 'qualified individual' that specifies eligibility criteria regardless of immigration status, with exceptions for those eligible under specific sections of the law.

Changed the statute citation for the assisted living exemption from 25-27-104 to 10-16-1203, reorganizing how the exemption is codified.

Removed provisions requiring managed care entities to submit payment and medical loss ratio data to the state department.

Removed the requirement for the state department to publish medical loss ratio data and audit findings on its website.

Removed provisions related to plan of care requirements for rehabilitation therapy services.

Clarified that assisted living residences with fewer than 19 beds must still comply with fire and local building codes, and refined the definition of major renovations to exclude system upgrades that don't require construction.

Updated the billing manual review process to ensure annual updates include all necessary CPT codes or provide links to the state department's list of CPT codes.

Added requirements for managed care entities to submit payment amounts and medical loss ratio data annually, with the state department publishing this information including audit findings.

Updated plan of care requirements to reference existing rehabilitation therapy definitions and limit signature requirements to those required by federal Medicare and Medicaid regulations.

Modified managed care payment timelines to require MCOs to issue payments within one year after provider rates are updated, and to notify MCOS of rate changes within 60 days.

Clarified that medical loss ratio means the percentage of premium revenue MCEs spend on health-care services and quality improvement activities.

Assisted living residences with fewer than 19 beds that have not undergone new construction or renovations are now explicitly exempt from complying with Facility Guidelines Institute (FGI) guidelines, while still maintaining compliance with fire and building codes.

Managed care entities must now submit annual reports to the state department detailing payment amounts and medical loss ratios, which the department must publish on its website.

The state department is prohibited from requiring physician signatures on Medicaid plans of care for physical therapy or occupational therapy beyond federal Centers for Medicare and Medicaid Services requirements.

Members receiving home and community-based services cannot lose those services if their disability and need for services have not changed in the preceding three years.

Beginning January 1, 2026, managed care organizations must issue payment to contracted providers within one year after provider rates are updated for claims that must be reprocessed.

Removed broad definitions of 'qualified individual' related to immigration status and premium tax credit eligibility that were present in the original version.

Clarified that healthcare affordability fee revenue is collected and expended from a specific 'CASH FUND' rather than generic 'MONEY'.

Capitalized language regarding public fund receipt in subsection (VIII) for emphasis, with no change to the underlying authority.

Removed explanatory footer text about how to interpret formatting symbols (capital letters, bold, dashes) that was part of the draft version but not needed in the final act.

Added a note indicating the bill is prepared for signatures and directing readers to legislative status resources for final action confirmation.

Added a new definition for 'qualified individual' to clarify eligibility for certain benefits regardless of immigration status, with specific exceptions for individuals eligible under other state programs.

Clarified that 'major renovations' for assisted living residences include changes affecting structural integrity, while excluding functional operation changes without construction or floor plan modifications.

Added new provisions requiring managed care entities to submit payment and medical loss ratio data annually, with the state department publishing this information on its website.

Established that billing manual updates must occur annually and include all necessary CPT codes or provide links to the state department's list of CPT codes.

Added provisions clarifying that transfers from governmental healthcare providers to the healthcare affordability and sustainability enterprise are not considered grants under state constitutional provisions.

Modified provisions related to the healthcare affordability and sustainability fee to clarify that it is a fee rather than a tax, based on specific purposes and benefit calculations.

Added additional House co-sponsors (Bacon, Bird, Boesenecker, Duran, English, Garcia, Gonzalez R., Jackson, Joseph, Lieder, Lindstedt, McCluskie, Ricks, Stewart K., Stewart R., Titone) to the House sponsorship list.

Updated the bill summary header from 'ENGROSSED' to 'REENGROSSED' and changed the date to March 26, 2025.

Removed the definition of 'medical loss ratio' which previously specified it as the percentage of premium revenue spent on health-care services and quality improvement activities.

Removed Section 5 which would have added a new statute (25.5-6-117) establishing plan of care requirements for rehabilitation therapy and defining 'plan of care' in the context of assisted living residences.

Assisted living residences with fewer than 19 beds that have not undergone new construction or major renovations are now exempt from complying with certain facility guidelines adopted by the state board of health.

The definition of 'major renovations' was expanded to include additions to a building's structure, changes affecting structural integrity, and upgrades to heating, cooling, and electrical systems that require construction.

Added a new requirement for the state department to notify managed care organizations of provider rate changes within 60 days of making those changes.

Reorganized and clarified sections related to managed care billing, medical loss ratio reporting, and plan of care requirements, moving some content to different sections for better organization.

Removed language requiring the executive director to ensure rule updates are easily identifiable, as this was considered redundant or less critical than other provisions.