The act requires the department of health care policy and financing, in coordination with the department of human services and the department of early childhood (state departments), to contract with a single county department of human or social services to administer a centralized member integrity service to conduct fraud investigations concerning eligibility for medicaid, the children's basic health plan, the supplemental nutrition assistance program, the Colorado child care assistance program, temporary assistance for needy families, and adult financial programs (public assistance programs), and benefit overpayments. The act creates the centralized member integrity service cash fund consisting of money recouped from member fraud investigations. The centralized member integrity service must be operational and utilized on July 1, 2027. On or before February 1, 2027, the act requires the state departments to establish aligned requirements for county departments of human or social services (county departments) to comply with through a performance-based contract established between the state departments and each county department. Prior to February 1, 2027, the state departments shall draft templates of the performance-based contract with the county departments for review and comment. On or before July 1, 2027, the state departments shall enter into a performance-based contract with each county department. The performance-based contract must establish requirements for the state departments and county departments to comply with in administering public assistance programs and establish corrective action protocols that are consistently utilized by the state departments. On or before September 1, 2026, the act requires the state departments to work together, and in consultation with the county departments, to establish a continuous quality improvement process to review data reported to the state departments by the county departments. The state departments must annually submit a report to the joint budget committee that includes an update on the continuous quality improvement process and data on the impact of the continuous quality improvement process. Beginning January 2027, and monthly thereafter, the state departments must establish a single, shared online dashboard used to publish county-level and statewide performance data for the public assistance programs on a monthly basis. This data must be published on each of the state department's website's in a publicly accessible format. Beginning July 1, 2028, the state departments must oversee a streamlined public benefits delivery model that consists of up to 12 cohorts of counties in the state that will coordinate public assistance program eligibility and distribute case processing work. The state departments shall enter into performance-based contracts with each cohort for administering a new public benefits delivery model to ensure public assistance programs are administered consistently and uniformly across the state. On or before July 1, 2026, the state departments must contract with a third-party contractor to help the state departments and county departments develop and implement a plan for transitioning to the new public benefits delivery model. The act establishes an implementation work group comprised of representatives of counties, the governor's office, the state departments, and nongovernmental organizations, to work with the third-party contractor to develop and implement the transition plan. The transition plan must be delivered to the joint budget committee by January 1, 2027. The act establishes the state cross-departmental policy alignment team to align the policies of the public assistance programs to improve service delivery and outcomes for recipients of public assistance benefits. The act makes a household eligible for fuel assistance payments if the household has not received low-income energy assistance program assistance in the previous 12 months and if it is eligible for the standard utility allowance under federal law. The act requires the department of health care policy and financing to certify to the department of revenue information regarding persons who are obligated to the state for overpayment of medicaid benefits and sets forth the process for distributing money withheld from a person's tax refund owed for overpayment of benefits. To implement the act, it includes appropriations from the general fund and various cash funds to the department of health care policy and financing, the department of human services, and the department of early childhood. The act appropriates money to the office of the governor for use by the office of information technology and to the department of law from reappropriated money received by other departments. The act decreases the appropriation from the federal child care development funds made in the annual general appropriation act for the 2026-27 state fiscal year to the department of early childhood for intrastate child care assistance program redistribution by $222,598.(Note: This summary applies to this bill as enacted.)
The act repeals the health-care delivery system reform incentive payments program in the Colorado healthcare affordability and sustainability enterprise (enterprise) and creates the hospital quality incentive program (incentive program) to use enterprise hospital provider fee revenue to make additional payments to hospitals that meet performance metrics in delivering safer and more effective care that improves patient outcomes and reduces preventable utilization to reduce health-care costs. Prior to implementing the program, the enterprise board shall approve the percentage of hospitals' reimbursement in the incentive program and the incentive program structure, performance measures, and scoring methodology. Once the incentive program is implemented, the total amount of payments made under the incentive program must not exceed 9% of the total reimbursements made to hospitals in the previous state fiscal year.(Note: This summary applies to this bill as enacted.)
The act creates the commission on medicaid (commission) to develop recommendations regarding implementation of new federal medicaid policy changes that go into effect in 2026, 2027, and 2028 and to support Coloradans impacted by those policy changes. The commission is required to:Convene at least 6 times but no more than 12 times between May 14, 2026 and December 11, 2026;Invite relevant state agency representatives and medicaid stakeholders to present and provide feedback on commission recommendations; andContract with a technical advisor to assist the commission in writing and submitting a report to the general assembly and the governor documenting the commission's process and any recommendations by December 11, 2026. The act appropriates $500,000 to the legislative department from the general fund to implement the act.(Note: This summary applies to this bill as enacted.)
If an audit of a medicaid provider who provides nonemergency medical transportation services or pediatric behavioral therapy is initiated after July 1, 2026, for services provided from January 1, 2022, through December 31, 2023, the act authorizes the department of health care policy and financing (HCPF) to determine and recover overpayments to a provider using statistical sampling and extrapolation. If an audit identifies a statistically significant pattern of alleged overpayments to a provider, the act authorizes the state auditor to use the same statistical sampling and extrapolation methods to audit services provided by the provider from January 1, 2024, through December 31, 2025. If the audit identifies an alleged overpayment, HCPF is required to issue a notice of the alleged overpayment within 60 days after the alleged overpayment is identified. The notice of alleged overpayment must include the basis of the alleged overpayment, the rationale for the alleged overpayment, the methodology used to calculate the alleged overpayment, and information on how HCPF identified the alleged overpayment. If HCPF enters into a contract for the purpose of conducting an audit, the contract must not be a contingency-based contract based on a percentage of the amount of recovery collected from the provider. After HCPF completes an audit of a provider, the state auditor's office is required to conduct an examination to determine that proper statistical sampling and extrapolation methods were used by HCPF when determining whether overpayments were made to a provider. The state auditor shall annually present a report of the findings to the legislative audit committee and the joint budget committee. The act reduces the general fund appropriation to HCPF for medical and long-term care services for Medicaid-eligible individuals by $6,861,775 and increases the cash fund appropriation to HCPF for medical and long-term care services for Medicaid-eligible individuals by $13,723,550.(Note: This summary applies to this bill as enacted.)
The act creates the Colorado behavior analyst licensing board (board) under the direction and supervision of the division of professions and occupations in the department of regulatory agencies. On and after July 1, 2028, an individual is prohibited from engaging in or offering the practice of applied behavior analysis unless the individual is licensed by the board. The board is authorized to license behavior analysts and assistant behavior analysts if they meet the requirements specified by the act and the rules adopted by the board pursuant to the act. An individual who seeks to practice as a behavior analyst or assistant behavior analyst must meet the following requirements:File an application for a license;Have a valid certification in good standing with a certifying entity;Complete a fingerprint-based criminal history record check;Carry professional liability insurance in an amount determined by the board by rule unless working as a public employee covered under governmental immunity; andIf the individual seeks to practice as an assistant behavior analyst, be supervised by a licensed behavior analyst and practice within the scope of practice established by rules of the board. The board may deny or refuse to renew a license, suspend or revoke a license, impose probationary conditions on a license, or issue a cease-and-desist letter or seek injunctive relief against a licensee or an applicant for licensure who has engaged in specified grounds for discipline or unprofessional conduct. The board may also send a licensee a letter of admonition or a confidential letter of concern under certain circumstances. The act exempts specified individuals from the licensing requirements established by the act. An individual who practices or offers or attempts to practice as a behavior analyst or assistant behavior analyst without being licensed pursuant to the act and who is not exempted from licensure commits a class 2 misdemeanor. The board may adopt rules as necessary to implement the act. The regulation of behavior analysts and assistant behavior analysts is scheduled for repeal on September 1, 2031. Before the repeal, the functions of the board in regulating applied behavior analysis are scheduled for review in accordance with the sunset law. The act requires the department of health care policy and financing (state department) to reimburse an applied behavior analysis provider for applied behavior analysis services provided by a behavior technician certified by a certifying entity to a medicaid member with autism spectrum disorder or other conditions for which coverage may be available under state department policies. Subject to federal approval, the state department shall reimburse the applicable applied behavior analysis provider for applied behavior analysis services provided by a behavior technician who is required by the state department to be certified by a certifying entity, but is not certified at the time of services, for services provided during one temporary period of not less than 45 days while the behavior technician is pursuing the certification if specified conditions are met. The department of human services (department) is required to prescribe and publish standards for the licensing and regulation of applied behavior analysis clinics (clinics). The department is authorized to adopt rules concerning specific subjects related to standards for clinics. Clinics are required to comply with specified requirements regarding local government zoning regulations, licensing fees, and qualifications for employees of the clinics. The act changes the definition of 'day treatment center' to 'day treatment facility' and requires that facilities that were not subject to the definition before the effective date of the act but that meet the amended definition submit an application for licensure by the department on or before August 1, 2026 , and become licensed before August 1, 2027.(Note: This summary applies to this bill as enacted.)
Joint Budget Committee. Current law authorizes medicaid reimbursement for therapy using equine movement provided by a licensed physical therapist, a licensed occupational therapist, or a certified speech-language pathologist. The bill repeals this provision and reduces the 2026-27 appropriation to the department of health care policy and financing by $181,514.(Note: This summary applies to this bill as introduced.)
The act recreates a provision that authorizes the state to retain the percentage of reimbursement that is in excess of the 50% federal match received for certain medicaid services provided (enhanced federal financial participation) during the COVID-19 pandemic. The provision is repealed once the reconciliation of all reimbursements and payments for services delivered during the period of enhanced federal financial participation has been completed.(Note: This summary applies to this bill as enacted.)
The act requires the nonemergency medical transportation broker (broker) to establish the transportation community advisory board (TCAB) and requires the state department of health care policy and financing (state department) to collaborate with the TCAB prior to establishing rules and processes for the safety and oversight of nonmedical transportation services and nonemergency medical transportation (NEMT) services. The act requires, in collaboration with the TCAB, certain rules for NEMT the state department must adopt. The state department may impose trip caps or market-share restrictions on a transportation provider (provider) as part of corrective action plan. The act requires providers to use vehicles equipped with 2-way video cameras and a video recording system when transporting members. The act establishes how the broker must roll out their implementation and requires the broker to provide all providers with software, a communication toolkit, training, and technical assistance to facilitate NEMT services. The broker may encourage medicaid members (members) to book transportation services at least 2 days before their requested transportation date, and the broker shall accept and make reasonable efforts to fulfill same-day and next-day transportation requests. The act requires providers, only after all service regions have been implemented, to accommodate member requests for preferred or alternate drivers when operationally feasible. The act requires the broker, and, if there is no broker, the providers to verify that individuals using the transportation services are eligible members during the scheduling of transportation services. The act prohibits the broker from operating, owning, or controlling a provider in Colorado. The act requires the broker to provide their trip assignment rules and procedures to the state department for approval and for publication on the state department's website. The act allows a transportation network company to provide NEMT services when a provider is unavailable. The state department shall ensure all transportation providers, drivers, and vehicles are credentialed, and services provided by noncredentialed drivers or in noncredentialed vehicles are not eligible for reimbursement. The act prohibits the state department from denying payment of services to providers if the provider provides scheduled transportation services in good faith based on the information provided by the broker or if the provider had no knowledge of an inaccuracy and the provider followed all applicable rules and procedures. Subject to available appropriations, the act requires the state department to audit providers and audit the broker annually. The act requires the state department to categorize all NEMT expenditures as medical services and make changes to the NEMT program as necessary to obtain medical services federal match rates for NEMT services. The act also eliminates the requirement that the state department provide transportation services as an administrative cost. The act reduces appropriations to the state department from the general fund by $76,639 and from the healthcare affordability and sustainability hospital provider fee cash fund by $20,941,853.(Note: This summary applies to this bill as enacted.)
The bill prohibits the department of health care policy and financing (department) from denying a medicaid member (member) the ability to purchase primary care services or enter into a direct primary care agreement. A member who purchases direct primary care services from a direct primary health-care provider or enters into a direct primary care agreement must sign a document acknowledging that the direct primary health-care provider is enrolled in the Colorado medical assistance program only as an ordering, prescribing, and referring provider; that the direct primary health-care provider does not accept medicaid payments for the services rendered; that the member cannot submit a claim for medicaid reimbursement for the services rendered by the direct primary health-care provider; and that the member retains the right to receive primary care services from a primary care provider who is enrolled in the Colorado medical assistance program.(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)
The bill prohibits a person, health-care provider, or mental health professional from knowingly performing surgery on, or prescribing, administering, or providing hormones or puberty blockers to, a minor for the purpose of altering the minor's biological sex characteristics, or providing mental health therapy, counseling, or referrals that promote or affirm a minor's belief that the minor was born in the wrong body or that the minor needs medical intervention to address distress related to the minor's biological sex (prohibited interventions). The bill prohibits the state from investigating or penalizing a minor's parent, or terminating the parent's rights, for refusing to consent to a prohibited intervention for the minor. A public school, health-care provider, or a governmental entity is prohibited from withholding information from a minor's parent regarding the minor's express desire to transition the minor's biological sex. The bill prohibits state or federal funding, medicaid reimbursement, and health insurance coverage from being used to pay for a prohibited intervention. A person who, as a minor, was subjected to a prohibited intervention may bring a civil action within 20 years after attaining the age of 18 years against the person, health-care provider, or mental health professional who performed or provided the prohibited intervention. The bill requires a regulator to revoke a health-care provider's or mental health professional's license for performing or providing a prohibited intervention. A person who knowingly performs or provides a prohibited intervention commits a class 5 felony, and the court is required to sentence the person to the maximum term of imprisonment and impose the maximum fine.(Note: This summary applies to this bill as introduced.)
