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 Sue Birch, Executive Director

May 26, 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 July 2011 meeting of the Medical Services Board of the Department of Health Care Policy and Financing. The meeting will be held on Friday, July 8, 2011, 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

July 2011 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, July 08, 2011, 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 11-04-01-A Revision to the Medical Assistance Rule Concerning Reimbursement for Home Health Services, Section 8.528.

Home Health. Rule Section 8.528 Reimbursement for Home Health Services currently states that a home health agency must obtain a Medicare denial prior to billing Medicaid for dual eligible clients who do not meet the homebound status requirement. The changes in this section of the rule will allow the home health agency to bill Medicaid for these dual eligible claims at the time of services. It will also require that an agency to obtain and retain a Medicare denial.

MSB 11-04-14-A Revision to the Medical Asssitance Rule Concerning Durable Medical Equipment and Disposable Medical Supplies.

Revision to the Medical Assistance Rule Concerning Durable Medical Equipment and Disposable Medical Supplies, Section 8.590.7.I. This rule gives the reimbursement rates for durable medical equipment and supplies. To address the state budget shortfall, the proposed changes to this section reduce the reimbursement rates for durable medical equipment and supplies that are from the fee schedule, or calculated using invoiced costs or manufacturer suggested retail prices. The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S., and 25.5-5-4-416 C.R.S.

MSB 11-04-14-B Revision to the Medical Assistance Rule Concerning Ambulatory Surgery Centers.

Revision to the Medical Assistance Rule Concerning Ambulatory Surgery Centers, Section 8.570.6.B. Unlike most service reimbursement rules, this rule includes a specific number used to calculate the reimbursement rate for ambulatory surgery centers. The Department proposes to align this rule with other reimbursement rules by removing the specific number and referencing the Department's fee schedule in the rule. The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. and 25.5-4-401, C.R.S.

MSB 11-03-08-A Revision to the Medical Assistance Rule Concerning the Prenatal Plus Program.

Prenatal Plus Program. This rule revision removes references to administrative functions formerly performed by the Colorado Department of Public Health and Environment and more clearly outlines and defines program criteria. Prior to July 1, 2011, programmatic administration of the Prenatal Plus Program was the responsibility of the Colorado Department of Public Health and Environment. Effective July 1, 2011, the program will be administered solely by the Department of Health Care Policy and Financing. The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2010).

MSB 11-03-22-B Revision tot he Medical Assistance rule Concerning Citizenship and Identity Documentation Requirements

Medicaid. The proposed rule amends 10 CCR 2505-10, Section 8.100.3.H to add language regarding the use of interfaces to confirm citizenship and/or identity requirements for Medicaid eligibility. The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), H.R. 2 allows states to verify citizenship and identity for individuals using a data file match with the Social Security Administration (SSA). This rule assists in streamlining the eligibility process. The federal authority for this rule is located at Pub.L. 111-3, section 211(2009). The state authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2010).

MSB 11-03-22-A Revision to the Medical Assistance Rule Concerning the Increase in Resource Limit of Medicare Savings Programs

This rule increases the resource limit for Qualified Medicare Beneficiary (QMB), Special Low-Income Medicare Beneficiaries (SLMB), and Qualified Individuals (QI) to $8,180 for a individual and $13,020 for a couple. The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2010).

MSB 11-05-10-A Revision to the Medical Assistance Rule Concerning Reduction to Outpatient Reimbursement

The purpose of this rule revision is to reduce the reimbursement for outpatient hospital services. The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2008).

“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