C.R.S. Section 25.5-6-204
Providers

  • reimbursement
  • intermediate care facility for individuals with intellectual disabilities
  • reimbursement
  • maximum allowable

(1)

Intentionally left blank —Ed.

(a)

For the purpose of making payments to intermediate care facilities for individuals with intellectual disabilities, the state department shall establish a price schedule to be readjusted every twelve months, that shall reimburse, subject to available appropriations, each provider, as nearly as possible, for its actual or reasonable cost of services rendered, whichever is less, its case-mix adjusted direct health-care services costs as defined in section 25.5-6-201 (9), and a fair rental allowance for capital-related assets as defined in section 25.5-6-201 (7). The state board shall adopt rules, including uniform accounting or reporting procedures, in order to determine the actual or reasonable cost of services and case-mix adjusted direct health-care services costs and the reimbursement therefor. The provisions of this paragraph (a) shall not apply to state-operated intermediate care facilities for individuals with intellectual disabilities.

(b)

State-operated intermediate care facilities for individuals with intellectual disabilities shall be reimbursed based on the actual costs of administration, property, including capital-related assets, and room and board, and the actual costs of providing health-care services, and such costs shall be projected by such facilities and submitted to the state department by July 1 of each year for the ensuing twelve-month period. Reimbursement to state-operated intermediate care facilities for individuals with intellectual disabilities shall be adjusted retrospectively at the close of each twelve-month period. The state board shall adopt rules to be effective by June 30, 1988, implementing the provisions of this paragraph (b). In the implementation of such rules, the state department shall ensure, by the establishment of classes of facilities, that the reimbursement to private, nonprofit, or proprietary state-operated intermediate care facilities for individuals with intellectual disabilities, as defined in section 25.5-10-202, is not adversely impacted.

(c)

Intentionally left blank —Ed.

(I)

Beginning in fiscal year 2013-14, and for each fiscal year thereafter, the state department is authorized to charge both privately owned intermediate care facilities for individuals with intellectual disabilities and state-operated intermediate care facilities for individuals with intellectual disabilities a service fee for the purposes of maintaining the quality and continuity of services provided by intermediate care facilities for individuals with intellectual disabilities. The service fee charged by the state department pursuant to this paragraph (c) will be assessed pursuant to rules adopted by the state board but must not exceed five percent of the total costs incurred by all intermediate care facilities for the fiscal year in which the service fee is charged. The state board shall adopt rules consistent with federal law in order to implement the provisions of this paragraph (c).

(II)

The moneys collected in each fiscal year pursuant to subparagraph (I) of this paragraph (c) shall be transmitted by the state department to the state treasurer, who shall credit the same to the service fee fund, which fund is hereby created and referred to in this paragraph (c) as the “fund”. The moneys in the fund shall be subject to annual appropriation by the general assembly to the state department to be used toward the state match for the federal financial participation to reimburse intermediate care facilities for individuals with intellectual disabilities pursuant to this section. Any unexpended and unencumbered moneys remaining in the fund at the end of any fiscal year shall remain in the fund and not be credited or transferred to the general fund or any other fund.

(2)

Intentionally left blank —Ed.

(a)

In addition to the actual or reasonable costs and the reimbursement therefor, the state department shall, subject to available appropriations, include an allowance equal to the change in the national bureau of labor statistics consumer price index from the preceding year to compensate for fluctuating costs. This amount shall be determined every twelve months when the statewide average cost is determined by adjusting for inflation. The provider’s allowable cost shall be multiplied by the change in the consumer price index measured from the midpoint of the provider’s cost report period to the midpoint of the provider’s rate period. This allowance is applied to all costs, including case-mix adjusted direct health-care services costs as defined in section 25.5-6-201 (9), less interest, up to the reasonable cost established and will be allowed to proprietary, nonprofit, and tax-supported homes; except that the allowance shall not be applied to the costs of state-operated intermediate facilities for individuals with intellectual disabilities.

(b)

Intentionally left blank —Ed.

(I)

The state board shall adopt rules to:

(A)

Determine and pay to privately owned intermediate care facilities for individuals with intellectual disabilities a reasonable share of the amount by which the reasonable costs of the categories of administration, property, and room and board, excluding food costs, exceed the actual cost in these categories only. The reasonable share shall be defined as twenty-five percent of the amount in the categories for each facility, not to exceed twelve percent of the reasonable cost.
(B)(Deleted by amendment, L. 2008, p. 1783, § 5, effective July 1, 2008.)(II)(Deleted by amendment, L. 2008, p. 1783, § 5, effective July 1, 2008.)(c) to (e)(Deleted by amendment, L. 2008, p. 1783, § 5, effective July 1, 2008.)(3) to (5)(Deleted by amendment, L. 2008, p. 1783, § 5, effective July 1, 2008.)(6) and (7) Repealed.

Source: Section 25.5-6-204 — Providers - reimbursement - intermediate care facility for individuals with intellectual disabilities - reimbursement - maximum allowable, https://leg.­colorado.­gov/sites/default/files/images/olls/crs2023-title-25.­5.­pdf (accessed Oct. 20, 2023).

25.5‑6‑101
Spousal protection - protection of income and resources for community spouse - definitions - amounts retained - responsibility of state department - right to appeal
25.5‑6‑102
Court-approved trusts - transfer of property for persons seeking medical assistance for nursing home care - undue hardship - legislative declaration
25.5‑6‑103
Court-approved trusts - transfer of property for persons seeking medical assistance - rule-making authority for trusts created on or after July 1, 1994 - undue hardship
25.5‑6‑104
Long-term care placements - comprehensive and uniform client assessment instrument - report - legislative declaration - definitions - repeal
25.5‑6‑105
Legislative declaration relating to implementation of single entry point system - repeal
25.5‑6‑106
Single entry point system - authorization - phases for implementation - services provided - repeal
25.5‑6‑107
Financing of single entry point system - repeal
25.5‑6‑108.5
Community long-term care studies - authority to implement - alternative care facility report
25.5‑6‑110
Private-public partnership education and information program concerning long-term care insurance authorized
25.5‑6‑113
Health home - integrated services - legislative declaration - contracting - definitions
25.5‑6‑115
Notification of federal immigration consequences
25.5‑6‑116
Community placement transformation - creation - report - repeal
25.5‑6‑201
Special definitions relating to nursing facility reimbursement
25.5‑6‑202
Providers - nursing facility provider reimbursement - exemption - rules - repeal
25.5‑6‑203
Nursing facilities - provider fees - federal waiver - fund created - rules - repeal
25.5‑6‑204
Providers - reimbursement - intermediate care facility for individuals with intellectual disabilities - reimbursement - maximum allowable
25.5‑6‑205
Collection of penalties assessed against nursing facilities - creation of cash fund
25.5‑6‑206
Personal needs benefits - amount - patient personal needs trust fund required - funeral and final disposition expenses - penalty for illegal retention and use
25.5‑6‑208
Nursing facility provider reimbursement - rules - definition - repeal
25.5‑6‑209
Establishment of nursing facility provider demonstration of need - criteria - rules
25.5‑6‑210
Additional supplemental payments - nursing facilities - funding methodology - reporting requirement - rules - repeal
25.5‑6‑301
Short title
25.5‑6‑302
Legislative declaration
25.5‑6‑303
Definitions - repeal
25.5‑6‑304
Administration
25.5‑6‑305
Provision of services for elderly and blind individuals and individuals with disabilities
25.5‑6‑306
Eligible groups
25.5‑6‑307
Services for the elderly, blind, and disabled
25.5‑6‑308
Cost of services
25.5‑6‑309
Special provisions - post-eligibility treatment of income
25.5‑6‑310
Special provisions - personal care services provided by a family - repeal
25.5‑6‑311
Duties of state department
25.5‑6‑312
Gifts - grants
25.5‑6‑313
Rules - federal authorization
25.5‑6‑314
Training for staff providing direct-care services to clients with dementia - rules - definitions
25.5‑6‑401
Short title
25.5‑6‑402
Legislative declaration - Prader-Willi syndrome
25.5‑6‑403
Definitions
25.5‑6‑404
Duties of the department of health care policy and financing and the department of human services
25.5‑6‑405
Relationship to other programs
25.5‑6‑406
Appropriations - reimbursement for services - direct support professionals - legislative declaration - definitions - repeal
25.5‑6‑407
Gifts - grants
25.5‑6‑408
Eligibility - fees
25.5‑6‑409
Services for persons with intellectual and developmental disabilities
25.5‑6‑409.3
Consolidated waiver - intellectual and developmental disabilities - conflict-free case management - legislative declaration - repeal
25.5‑6‑409.5
Transition plan for youth with intellectual and developmental disabilities to adult services - legislative declaration - report - rules - cash fund
25.5‑6‑410
Qualification for federal funding
25.5‑6‑411
Personal needs trust fund required
25.5‑6‑413
Elimination of subminimum wage - transition plan for individuals with disabilities - waiver - legislative declaration - definition
25.5‑6‑601
Short title
25.5‑6‑602
Legislative declaration - no entitlement created
25.5‑6‑603
Definitions
25.5‑6‑604
Cost of services
25.5‑6‑605
Relationship to single entry point for long-term care - repeal
25.5‑6‑606
Implementation of program for persons with mental health disorders authorized - federal waiver - duties of the department of health care policy and financing and the department of human services - rules
25.5‑6‑607
Implementation of part contingent upon receipt of federal waiver - repeal of part
25.5‑6‑701
Short title
25.5‑6‑702
Legislative declaration - no entitlement created
25.5‑6‑703
Definitions - repeal
25.5‑6‑704
Implementation of home- and community-based services program for persons with brain injury authorized - federal waiver - duties of the department - rules - repeal
25.5‑6‑705
Implementation of part contingent upon receipt of federal waiver - repeal of part
25.5‑6‑706
Rate structure - rules - quality assurance
25.5‑6‑901
Disabled children care program - eligibility criteria - documentation requirements - report to the general assembly
25.5‑6‑902
Children’s personal assistance services and family support program - repeal
25.5‑6‑903
Residential child health-care program - waiver - home- and community-based services - rules
25.5‑6‑1101
Definitions
25.5‑6‑1102
Service model - consumer-directed care - repeal
25.5‑6‑1103
Reporting
25.5‑6‑1201
Legislative declaration - repeal
25.5‑6‑1202
Definitions
25.5‑6‑1203
In-home support services - eligibility - licensure exclusion - in-home support service agency responsibilities - rules - repeal
25.5‑6‑1204
Provision of services - duties of state department - gifts - grants
25.5‑6‑1205
Accountability - rate structure - rules
25.5‑6‑1206
Report - repeal
25.5‑6‑1207
Repeal of part
25.5‑6‑1301
Legislative declaration
25.5‑6‑1302
Definitions
25.5‑6‑1303
Pilot program - complementary or alternative medicine - rules
25.5‑6‑1304
Repeal of part
25.5‑6‑1401
Legislative declaration
25.5‑6‑1402
Definitions
25.5‑6‑1403
Waivers and amendments
25.5‑6‑1404
Medicaid buy-in program - eligibility - premiums - medicaid buy-in fund - report - rules - repeal
25.5‑6‑1405
Rule-making authority
25.5‑6‑1406
Availability of federal financial assistance under medical assistance
25.5‑6‑1501
Community transition services and supports - legislative declaration - rules
25.5‑6‑1601
Definitions
25.5‑6‑1602
State department to request increase in reimbursement rate for certain services
25.5‑6‑1603
Minimum wage - wage pass-through requirement for certain home care agencies - applicability - reports - recovery
25.5‑6‑1604
Training for home care agency employees - process for reviewing and enforcing training requirements
25.5‑6‑1605
Exemptions
25.5‑6‑1701
Legislative declaration
25.5‑6‑1702
Definitions
25.5‑6‑1703
Case management system - defined service areas - case management services - only willing and qualified provider exemption - rules
25.5‑6‑1704
Intellectual and developmental disability determination - functional eligibility determination - rules
25.5‑6‑1705
Person-centered support plan
25.5‑6‑1706
Termination of long-term services and supports for member receiving services
25.5‑6‑1707
Records and confidentiality of information
25.5‑6‑1708
Performance audits - Colorado local government audit law - public disclosure of board administration and operations
25.5‑6‑1709
Community-centered board designation - rules
25.5‑6‑1801
Legislative declaration
25.5‑6‑1802
Definitions
25.5‑6‑1803
Development of spending plan
25.5‑6‑1804
Spending plan - approval by joint budget committee - reporting
25.5‑6‑1805
Home- and community-based services improvement fund - creation - transfer - expenditures
25.5‑6‑1806
Repeal of part
25.5‑6‑1901
Definitions
25.5‑6‑1902
Community first choice option - covered services - state plan amendment
25.5‑6‑1903
Permissible services and supports
25.5‑6‑1904
Maintenance of effort
25.5‑6‑1905
Eligibility
Green check means up to date. Up to date

Current through Fall 2024

§ 25.5-6-204’s source at colorado​.gov