July 2007 Rule Notice

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COLORADO DEPARTMENT OF HEALTH CARE POLICY & FINANCING

1570 Grant Street, Denver, CO 80203-1818 (303) 866-2993 (303) 866-4411 Fax (303) 866-3883 TTY

John Hickenlooper, Governor Susan E. Birch, MBA, BSN, RN, Executive Director

November 30, 2011

The Honorable Scott Gessler

Secretary of State

1560 Broadway, 2nd Floor

Denver, Colorado 80203

Dear Mr. Gessler:

Attached is the Notice of Proposed Rules concerning Medical Assistance rules to be considered for final adoption at the January 2012 meeting of the Medical Services Board of the Department of Health Care Policy and Financing. The meeting will be held on Friday, January 13, 2012, beginning at 9:00 A.M., in the sixth floor conference room at the Capitol Center, 225 East 16th Avenue, Denver, CO 80203.

This notice is submitted to you for publication, pursuant to § 24-4-103(3)(a) and (11)(a), C.R.S.

Sincerely,

Judi Carey,

Coordinator

Medical Services Board

attachments

“The mission of the Department of Health Care Policy & Financing is to purchase cost-effective health care for qualified, low-income Coloradans.”

http://www.chcpf.state.co.us


January 2012 Rule Notice

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NOTICE OF PROPOSED RULES

The Medical Services Board of the Colorado Department of Health Care Policy and Financing will hold a public meeting on Friday, January 13, 2012, beginning at 9:00 a.m., in the sixth floor conference room at the Capitol Center, 225 East 16th Avenue, Denver, CO 80203. Reasonable accommodations will be provided upon request prior to the meeting, by contacting the Medical Services Board Coordinator at 303-866-4416.

A copy of the full text of these proposed rule changes is available for review from the Medical Services Board Office, 1570 Grant Street, Denver, Colorado 80203, tel. (303) 866-4416, fax (303) 866-4411. Written comments may be submitted to the Medical Services Board Office on or before close of business the Wednesday prior to the meeting. Additionally, the full text of all proposed changes will be available approximately one week prior to the meeting on the internet at http://www.chcpf.state.co.us/msb/agenda.

MSB 11-09-07-A. Revision to the Medical Assistance Rule Concerning Long Term Care Eligibility, Section 8.100.

The proposed rule revises 10 CCR 2505-10, Sections 8.100.5 and 8.100.7 to improve client access to Long-Term Care Medical Assistance by reorganizing and clarifying eligibility requirements. This will assist in streamlining the eligibility process and reduce administrative burden to eligibility sites and clients.

Additionally, spouses that remain in the community, have Medical Assistance and have an institutionalized spouse will now be able to retain Medical Assistance and also maintain a monthly income allowance. This will help keep them from becoming impoverished while remaining in the community.

The federal authority for this rule is located at 42 CFR Part 435, 20 CFR Part 416, Title XIX and Section 1924 of the Social Security Act.

The state authority for this rule is contained in 25.5-1-301 through 25.5-1-303, 25.5-105 and 25.5-203 C.R.S. (2011).

MSB 11-11-04-A. Revision to the Medical Assistance Rule Concerning Determining Reimbursement Rates of Pharmaceuticals, Section 8.800.13

The statute regarding the Pharmaceutical Reimbursement Calculation methodology will be presented at the December Medical Services Board meeting. The rules for the Pharmaceutical Reimbursement Calculation located at 10 C.C.R. 2505-10, Section 8.800.13 will be updated to continue using the current rule for pharmaceutical reimbursement. This rule is scheduled to expire on January 7, 2012. The proposed change will ensure that there is a pharmaceutical reimbursement rule in place and allow the state to continue to work toward a rule that meets CMS approval.

MSB 11-11-21-A. Revision to the Medical Assistance Rule Concerning Services for Clients in Psychiatric Residential Treatment Facilities or Residing in Therapeutic Residential Child Care Facilities, Section 8.765.4.A.5.

This rule change eliminates the requirement for a Department of Human Services Trails system level C determination to be eligible for placement into a Psychiatric Residential Treatment Facility (PRTF).

As of January 1, 2012, a thorough medical necessity evaluation known as a Colorado Client Assessment Record (CCAR) will be done once a client has been enrolled into a PRTF. This information will be housed in a Division of Behavioral Health (DBH) system instead of the Trails system, and does not use a “levels” system. Therefore, this requirement is no longer relevant.

MSB 11-11-11-A. Revision to the Medical Assistance Rule Concerning Services for Clients in Psychiatric Residential Treatment Facilities or Residing in Therapeutic Residential Child Care Facilities, Section 8.765.12.B.

Section 8.765.12.B states, "If the Referral Agency (defined as the Division of Youth Corrections, County Departments of Human/Social Services who have legal custody of a client, Behavioral Healthcare Organization or Community Mental Health Center that refers the client to a PRTF or RCCF providing mental health services for the purpose of the placement through the Child Mental Health Treatment Act) disagrees with the Multidisciplinary Team's Assessment and the client is denied admission, the client has the right to appeal pursuant to 10 C.C.R. 2505-10, Section 8.057."

The Department of Health Care Policy and Financing is not the managing authority over RCCFs, the Department of Human Services is. Therefore, if a client would like to appeal denied admission to an RCCF, they need to appeal to the Department of Human Services. Clients cannot appeal denied admission to an RCCF under our appeal rules because we are not the managing authority, thus it is not our decision.

Coinciding with that, if section 8.765.12.B is not deleted, it would actually contradict Volume 7 by giving our department authority over a client appeal process that the Department of Human Services actually has the authority over as defined in their Volume 7.

MSB-11-10-27-A. Revision to the Medical Assistance Rule Concerning the Retroactive Eligibility for the Aged, Blind or Disabled Categories, Section 8.100.5.C.2.

The purpose of this rule revision is to clarify the criteria for granting retroactive eligibility to aged, blind, or disabled individuals who are found to be SSI eligible.

The federal authority for this rule is located at 42 CFR §435.914 and 42 USC §1396a(a)(34).

The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2011); 25.5-4-101(1), C.R.S. (2011).

MSB 11-10-25-A. Revision to the Medical Assistance Rule Concerning Adults without Dependent Children, Section 8.100.1, 8.100.3, 8.100.5, 8.100.6

The proposed rule amends 10 CCR 2505-10, Section 8.100 to add language regarding the Adults without Dependent Children (AwDC) program. House Bill 09-1293, the “Colorado Health Care Affordability Act” will generate new revenue to expand public health insurance to individuals without Medicaid dependent children living in their home who have income up to 100% of the Federal Poverty Level (FPL). The Department does not have the financial resources to provide services to the entirety of the AwDC population, and has requested federal authority through a Demonstration Waiver under Section 1115 of the Social Security Act to provide services to a subset of that potentially eligible population. Specifically, Colorado has requested approval from CMS to expand Medicaid coverage to the AwDC population with income at or below 10% FPL with an enrollment cap of 10,000 individuals and a waitlist of eligible individuals beyond that enrollment. As part of the Demonstration, the state requested the flexibility to expand the enrollment beyond 10,000 individuals and the ability to increase the income threshold beyond the 10% FPL, if funding allows.

The federal authority for this rule is located in the optional eligibility category under section 1902(k)(2) of the Social Security Act (the Act) that was added by the Patient Protection and Affordable Care Act of 2010 (ACA).

The state authority for this rule is contained in 25.5-4-402.3(4)(b)(IV)(C), C.R.S. (2011).

MSB 11-10-06-A. Revision to the Medical Assistance Rule Concerning the Medicaid Buy-In Program for Working Adults with Disabilities, Section 8.100

The proposed rule amends 10 CCR 2505-10, Section 8.100 to add language regarding the Medicaid Buy-In Program for Working Adults with Disabilities. House Bill 08-1072, “Medicaid Buy-In for Disabled Persons,” authorized Colorado to implement a Medicaid Buy-In program for individuals with disabilities. This program will have an income limit of 450% of FPL, no asset limit, and sliding scale premiums. It is funded by House Bill 09-1293, the “Colorado Health Care Affordability Act” which generates new revenue to expand public health insurance coverage to more Coloradans. Ticket to Work-Work Incentives Improvement Act (TWWIIA), Section 201, governs the provision of health care services to workers with disabilities by establishing a Medicaid State Plan optional buy-in eligibility group.

The federal authority for this rule is located in Section 201 of the Ticket to Work and Work Incentive Improvement Act of 1999, Public Law 106-170.

The state authority for this rule is contained in 25.5-4-402.3(4)(b)(IV)(C), C.R.S. (2011), and 25.5-6-1401 through 25.5-6-1406, C.R.S. (2011).

MSB 11-07-28-A. Revision to the Medical Assistance Rule Concerning the Colorado Indigent Care Program, Section 8.904.

Currently, applicants for the Colorado Indigent Care Program (CICP) who appear to meet Medicaid eligibility requirements must be receive a denial of Medicaid eligibility before being enrolled in the CICP. On March 1, 2012, the Department will implement an expansion of Medicaid to Adults without Dependent Children (AwDC) up to 10% of the federal poverty level (FPL) for 10,000 enrollees. After the first 10,000 enrollees, there will be a waiting list for enrollment in Medicaid. The CICP rules, 10 C.C.R. 2505-10, Section 8.904, are being revised to clarify that applicants who are on the Medicaid waiting list can be enrolled in CICP.

The authority for this rule is contained in 25.5-3-101, et seq., C.R.S.

MSB 11-09-27-A. Revision to the Medical Assistance Rule Concerning Medicaid Managed Care Program, Section 8.205.

The proposed changes to the Medicaid Managed Care Program rule (1) modify the language so it covers Primary Care Case Management programs, including the Accountable Care Collaborative program; (2) give the Department authority to mandatorily enroll clients in the Adults without Dependent Children eligibility category into the Accountable Care Collaborative program; and (3) remove the provision that clients may be charged for services if they do not get a required referral.

The authority for this rule is contained in 25.5-5-401 through 25.5-5-414, C.R.S. (2010).

“The mission of the Department of Health Care Policy & Financing is to purchase cost-effective health care for qualified, low-income Coloradans.”

http://www.chcpf.state.co.us