June 10, 2016 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, June 10, 2016, beginning at 9:00 a.m., in the eleventh floor conference room at 303 East 17th Avenue, Denver, CO 80203. Reasonable accommodations will be provided upon request for persons with disabilities. Please notify the Board Coordinator at 303- 866-4416 or or the 504/ADA Coordinator at least one week prior to the meeting.
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, (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 Department’s website at
This notice is submitted to you for publication, pursuant to § 24-4-103(3)(a) and (11)(a), C.R.S.
MSB 15-12-18-A, Revision to the Medical Assistance Program Integrity Rule Concerning the Definition of Medical Necessity, Section 8.076.1.8; and EPSDT Rule Concerning the Definition of Medical Necessity, Section 8.280.
Medical Assistance. The Department proposes revisions to the definition of “medical necessity” in order to create a uniform definition to be used across all applicable Medical Assistance program rules.
The statutory authority for this rule change is contained in 42 CRF 440.230(d) and §§ 25.5-1-301 through 25.5-1-303, C.R.S. (2015).
MSB 16-01-30-A, Revision to the Home and Community Based Services Elderly, Blind, and Disabled Waiver Rule Concerning Home Modification, Section 8.493
Medical Assistance. The rules set forth at 10 CCR 2505-10 Section 8.493 are being revised to allow the Department to incorporate significant changes developed over the last year to the home modification benefit available to clients on the four adult Long Term Services and Supports (LTSS) waivers. The cornerstone of these changes has been the interagency agreement with the Division of Housing, Department of Local Affairs (DOH). With our new DOH partners, we have developed
ways to increase the quality of home modifications done throughout the state and reduce the difficulties encountered by clients during the home modification process. The rule is being changed
to reflect that process. The main areas of change have been 1), reducing miscommunication and shortening timeframes by creating standard forms and processes; 2), increased physical inspections by DOH to promote consistently high quality work; and 3), provider billing guidelines to protect the tax payers from overpayment and reduce the possibility of fraud. We established and have met with the Home Modification Stakeholder Workgroup monthly since January 2015 for input and recommendations on these changes.
The statutory authority for this rule changeis contained in 42 U.S.C. §1396n©; §25.5-6-307, §25.5-6-606; §25.5-6-704; §25.5-6-1303; and§§ 25.5-1-301 through 25.5-1-303 C.R.S (2015).