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HB 23-1228 CO
Became Law

Nursing Facility Reimbursement Rate Setting

CO · session 2023A · Assembly / House · bill

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Introduced Mar 3, 2023

Latest action (May 30, 2023) Introduced In House - Assigned to Public & Behavioral Health & Human Services

Summary

The act adjusts the supplemental medicaid payment rates a qualifying nursing facility receives from the department of health care policy and financing (state department). Beginning July 1, 2024, the payment must not be less than 12% of total provider fee payments and must be adjusted for fiscal years 2024-25 and 2025-26. No later than July 1, 2026, the payment must not be less than 15% of total provider fee payments and must be annually adjusted thereafter. Current law limits the annual increase of the general fund share of the aggregate statewide average of the per diem rate to not more than 3%. The act removes this limitation and requires that the general fund share be calculated based on specific percentage increases. The act requires the state department to initiate a process no later than July 1, 2023, to remove the medicare costs from the provider rate setting by July 1, 2026. The act repeals the requirement that only such costs as are reasonable, necessary, and patient-related be reported for reimbursement purposes. The act authorizes the state department to require a nursing facility, as a condition of receiving medicaid funds, to submit any documentation necessary to ensure the state's interest in transparency, stability, and sound fiscal stewardship. As part of developing and implementing a transition plan to regulate nursing facility reimbursement, the act requires the state department to: No later than July 1, 2026, define "nursing home reimbursement" and provide payments to nursing facilities; Engage with stakeholders regularly to seek input on any proposed methodology changes; and From November 1, 2023, to November 1, 2026, submit an annual report to the joint budget committee of the general assembly regarding the implementation process. Each nursing facility that receives medicaid funds is required to submit a plan to the state department that demonstrates how the nursing facility will: Improve the health and safety of the nursing facility's residents, including infection control and staffing; Increase access to care; Improve financial sustainability, including opportunities for diversification of business lines and stabilization of revenue streams; and Promote innovation to meet the emerging needs of individuals with disabilities and aging and older adults. The act requires the state department to issue additional supplemental payments to nursing facility providers with disproportionately high medicaid utilization, to facilities that are geographically critical to ensuring access to care, and to facilities that admit compassionate release individuals from the department of corrections. The act requires each nursing facility that receives medicaid funds to develop and submit a plan to the state department that meets the state department's standards and demonstrates how the nursing facility will improve the health and safety of the nursing facility's residents, increase access to care, improve financial sustainability, and promote innovation to meet the emerging needs of individuals with disabilities and aging and older adults. Effective July 1, 2028, the act repeals the requirement that the state department exempt certain nursing facility providers from the provider fee. Effective July 1, 2026, the act repeals: The process for providing a wage enhancement supplemental payment to eligible nursing home providers that pay their employees a wage of at least $15 per hour; and Requirements for issuing additional supplemental payments to nursing facility providers that meet certain requirements. For the 2023-24 state fiscal year, the act appropriates $30,509,457 from the general fund to the state department for medical and long-term care services for medicaid eligible individuals. For the 2023-24 state fiscal year, the general assembly anticipates that the state department will receive $31,754,740 in federal funds for medical and long-term care services for medicaid eligible individuals to implement the act. APPROVED by Governor May 30, 2023 EFFECTIVE May 30, 2023 (Note: This summary applies to this bill as enacted.)

Sponsors (4)

  • Julie McCluskie · primary
  • Jenny Willford Democratic · primary
  • Rachel Zenzinger · primary
  • Jim Smallwood · primary

Action history (14)

  1. May 30, 2023 Governor Signed · executive
  2. May 17, 2023 Sent to the Governor · executive
  3. May 17, 2023 Signed by the President of the Senate · upper
  4. May 17, 2023 Signed by the Speaker of the House · lower
  5. Apr 24, 2023 Senate Third Reading Passed - No Amendments · upper
  6. Apr 21, 2023 Senate Second Reading Special Order - Passed - No Amendments · upper
  7. Apr 21, 2023 Senate Committee on Appropriations Refer Unamended - Consent Calendar to Senate Committee of the Whole · upper
  8. Apr 17, 2023 Introduced In Senate - Assigned to Appropriations · upper
  9. Apr 15, 2023 House Third Reading Passed - No Amendments · lower
  10. Apr 14, 2023 House Second Reading Special Order - Passed with Amendments - Committee · lower
  11. Apr 14, 2023 House Committee on Appropriations Refer Amended to House Committee of the Whole · lower
  12. Apr 3, 2023 House Committee on Finance Refer Unamended to Appropriations · lower
  13. Mar 21, 2023 House Committee on Public & Behavioral Health & Human Services Refer Amended to Finance · lower
  14. Mar 3, 2023 Introduced In House - Assigned to Public & Behavioral Health & Human Services · lower

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