Responsibility of the department of health care policy and financing
- provider reimbursement
(1)The state department shall be responsible for:
(a)Execution of such contracts with providers for partial reimbursement of costs for medical services rendered to the medically indigent as the state department shall determine are necessary for the program;
(b)Promulgation of such reasonable rules as are necessary for the program;
(c)Submission of the report required in section 25.5-3-107; and
(d)Application for federal financial participation under the program.
(2)The contracts required by paragraph (a) of subsection (1) of this section shall be negotiated between the state department and the various general providers, as defined in section 25.5-3-103 (3), and shall include contracts with providers to provide tertiary or specialized services. The state department may award such contracts upon a determination that it would not be cost effective nor result in adequate quality of care for such services to be developed by the contract providers, or upon a determination that the contract providers are unable or unwilling to provide such services.
(3)The state department shall establish procedures requiring the provider to provide for proof of indigency to be submitted by the person seeking assistance, but the provider shall be responsible for the determination of eligibility.
(4)The state department shall establish procedures so that the providers of medical services rendered to the medically indigent cover geographic regions of the state.
(5)Intentionally left blank —Ed.
(a)The responsibilities of providers who provide medical care through the program for the medically indigent are as follows:
(I)Denver health and hospitals, including associated physicians, shall, up to its physical, staff, and financial capabilities as provided for under this program, be the primary providers of medical services to the medically indigent for the city and county of Denver.
(II)Intentionally left blank —Ed.
(A)University hospital and the physicians and other faculty members of the health sciences center shall, up to their physical, staff, and financial capabilities as provided for under this program, be the primary provider of medical services to the medically indigent for the Denver primary metropolitan statistical area.
(B)University hospital and the physicians and other faculty members of the health sciences center shall be the primary provider of such complex care as is not available or is not contracted for in the remaining areas of the state up to their physical, staff, and financial capabilities as provided for under this program.
(b)Any two or more providers awarded contracts may, with the approval of the state department, redistribute their respective populations and associated funds.
(c)Every provider who provides medical care through the program for the medically indigent shall comply with all procedures established by the state department.
(6)The state department shall establish procedures that allocate funds to providers based on the anticipated utilization of services.
(7)A provider receiving reimbursement pursuant to this section shall transfer a medically indigent patient to another provider only with the prior agreement of the provider.
(8)Intentionally left blank —Ed.
(a)Every provider receiving reimbursement pursuant to this section shall prioritize for each fiscal year the medical services which it will be able to render, within the limits of the funds which will be made available by the state department.
(b)Such medical services shall be prioritized in the following order:
(I)Emergency care for the full year;
(II)Any additional medical care for those conditions the state department determines to be the most serious threat to the health of medically indigent persons;
(III)Any other additional medical care.
(9)A provider receiving reimbursement pursuant to this section shall not be liable in civil damages for refusing to admit for treatment or for refusing to treat any medically indigent person for a condition which the state department or the provider has determined to be outside of the scope of the program.
(10)Intentionally left blank —Ed.
(a)A medically indigent person who wishes to be determined eligible for assistance under this part 1 shall comply with the eligibility requirements set by the state department.
(b)A medically indigent person requesting assistance under this part 1 specifically authorizes the state department or provider to:
(I)Use any information required by the eligibility requirements set by the state department for the purpose of verifying eligibility; and
(II)Obtain records pertaining to eligibility from a financial institution, as defined in section 15-15-201 (4), C.R.S., or from any insurance company.
(c)A medically indigent person requesting assistance under this part 1 shall be provided language clearly explaining the provisions of this subsection (10).
(11)With the approval of the state department, any provider awarded a contract may enter into subcontracts or other agreements for services related to the program.
(12)Providers awarded contracts shall not be paid from funds made available for this program up to the extent, if any, of their annual financial obligation under the Hill-Burton act.
(13)When adopting or modifying procedures under this part 1, the state department shall notify each provider, who is contracted to provide medical care through the program for the medically indigent, at least thirty days prior to implementation of a new procedure. The state department shall hold a meeting for all providers at least thirty days prior to the implementation of a new procedure.
(14)The state department shall require any hospital provider who may receive payment under the program to annually submit data relating to the hospital’s number of medicaid-eligible in-patient days and the hospital’s total in-patient days in a form specified by the state department. The hospital provider shall verify the data to the state department through the program audit procedures required by the state department. The state department shall include this information by hospital in the department’s annual budget request to the joint budget committee of the general assembly and in the report required by section 25.5-3-107.
(15)To qualify for the program’s payment formula disproportionate share hospital factor, as described in rule by the state board consistent with the provisions of this part 1, a hospital provider’s percent of medicaid-eligible in-patient days relative to total in-patient days shall be equal to or exceed one standard deviation above the mean.
(16)After receiving approval by the state department, a community health clinic may utilize moneys received pursuant to this article, and any gifts, grants, and donations, for the development and implementation of demonstration projects that may include but need not be limited to coordination of care and disease management.
(17)Subject to adequate funding being made available under section 25.5-4-402.4, the Colorado healthcare affordability and sustainability enterprise created in section 25.5-4-402.4 (3) shall increase hospital reimbursements up to one hundred percent of hospital costs for providing medical care under the program.
(18)and (19) Repealed.
(20)Intentionally left blank —Ed.
(a)Notwithstanding any other provision of law, for the state fiscal year starting July 1, 2021, and any subsequent fiscal years, if a provider submits a certification of public expenditures pursuant to 42 CFR 433.51 (b), the state department shall retain any federal money payable as reimbursement for the expenditure in excess of fifty percent of the expenditure amount; except that the state department shall only retain the federal money based on the date of service as long as the increased reimbursements and payments pursuant to the federal “Families First Coronavirus Response Act”, Pub.L. 116-127, are still available. The state treasurer shall transfer such money to the general fund created in section 24-75-201 for appropriation to the state medical assistance program.
(b)This subsection (20) is repealed, effective December 31, 2024.
Section 25.5-3-108 — Responsibility of the department of health care policy and financing - provider reimbursement - repeal,
https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-25.5.pdf (accessed Oct. 20, 2023).