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

August 31, 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 October 2011 meeting of the Medical Services Board of the Department of Health Care Policy and Financing. The meeting will be held on Friday, October 14, 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

October 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, October 14, 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 11-08-02-A Revision to the Medical Assistance Rule Concerning Durable Medical Equipment and Disposable Medical Supplies, Section 8.590.7.

Revision to the Medical Assistance Rule Concerning Durable Medical Equipment and Disposable Medical Supplies, Section 8.590.7. This amendment to the Reimbursement section of the Durable Medical Equipment and Disposable Medical Supplies rule adds the reimbursement methodology for equipment modifications, service, and repairs. There is no change to the methodology, and the Department currently uses this methodology in practice. However, it was inadvertently omitted from the rule. This amendment corrects the omission.

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 11-08-31-A Revision to the Medical Assistance Rule Concerning Pharmaceutical Methodology Change, Section 8.800.13

The statute regarding the Pharmaceutical Reimbursement Methodology Change will be presented at the September Medical Services Board meeting. Effective September 9, 2011, the rules for Pharmaceutical Reimbursement Calculation located at 10 C.C.R. 2505-10, Section 8.800.13 will be updated due to the changes in availability of information used to determine current rates.

MSB 11-06-08-A Revision to the Medical Assistance rule Concerning Clients in Psychiatric Residential Treatment Facilities or Residing in Therapeutic Residential Child Care Facilities, Section 8.765

On July 1, 2006, The Center for Medicare and Medicaid Services (CMS) no longer reimbursed states for services provided by Residential Treatment Centers (RTCs). Three Models of care were distinctly defined, and these models were the Psychiatric Residential Treatment Facilities (PRTFs), Therapeutic Residential Child Care Facilities (TRCCFs), and the Residential Child Care Facilities (RCCFs).

There are two main proposed changes:

1.  Replacing TRCCFs with RCCFs that provide mental health services. This is to align with the Department of Human Services practices and rules, and to promote continuity of care for children who need therapeutic services intermittently.

Remove the requirement that an assessment called the Colorado Client Assessment Record (CCAR) be completed a child/youth prior to placement. Once a child/youth is placed, the physician of the facility will complete a CCAR in the Trails system to determine what level of care is needed for the child/youth. This will improve access while maintaining medical necessity standards. Additionally, it will prevent RCCFs from being classified as Institutions for Mental Diseases (IMD) by CMS.

MSB 11-06-08-B Revision to the Medical Assistance rule Concerning Residential Treatment Center Reimbursement, Section 8.766

On July 1, 2006, The Center for Medicare and Medicaid Services (CMS) no longer reimbursed states for services provided by Residential Treatment Centers (RTCs). To replace RTCs in Colorado, three new models of care were created, and these models were the Psychiatric Residential Treatment Facilities (PRTFs), Therapeutic Residential Child Care Facilities (TRCCFs), and the Residential Child Care Facilities (RCCFs).

Although most of the rules in Volume 8 pertaining to RTCs were deleted, this entire section of 8.766 which focuses on RTCs was overlooked and needs to be removed to ensure compliance with CMS.

MSB 11-08-24-A Revision to the Medical Assistance rule Concerning SSI Medicaid Eligibility Effective Date Rules for Children Under 21, Section 8.100.6.C

The proposed language was approved for publication effective September 1, 2008. However, it was subsequently deleted through an administrative error effective April 1, 2009. The proposed rule is being presented in order to reestablish the previously approved language.

The purpose of this rule change is to revise the Supplemental Security Income (SSI) Medicaid eligibility requirements to incorporate changes in federal law governing the effective date of eligibility for individuals under 21 and to provide criteria for granting eligibility to infants who are found to be disabled shortly after birth.

The federal authority for this rule is located at 42 CFR §435.120, 42 CFR §435.909(b)(1), 42 CFR §435.914, 42 USC §1396a(a)(10)(A)(i)(II)(cc).

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 11-08-15-A Revision to the Medical Assistance rule Concerning Nursing Facility Provider Fees and Reimbursement, Sections 8.443.11, 8.443.12 and 8.443.17

Nursing Facility Provider Fees and Reimbursement. Senate Bill 11-125 increased the maximum fee to be assessed on Class I nursing facilities and re-ordered the hierarchy of supplemental payments funded by nursing facility provider fees. The new hierarchy and higher fee rate means that the pay-for-performance component will be fully funded; therefore, the pay-for-performance scale is changed to a $1 to $4 per Medicaid day add-on consistent with the recommendations of the Senate Bill 06-131 committee. In addition, pursuant to Senate Bill 11-125, a supplemental payment component for acuity or case-mix of Medicaid residents has been added to the list of components funded by nursing facility provider fees. Revisions to the Pay for Performance and Provider Fee rules, 10 C.C.R. 2505-10, Sections 8.443.11, 8.443.12 and 8.443.17., are being made accordingly.

The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. and in 25.5-6-202, C.R.S.

MSB 11-07-07-A Revision to the Medical Assistance rule Concerning Home and Community Based Services for the Supported Living Services Program, Section 8.500.9

The rule implementing the HCBS Program for the Supported Living Services Program, 10 C.C.R. 2505-10, Section 8.500.9 is being amended to incorporate the requirements of the existing HCBS Waiver, update language and plans for service that are out of date and includes language specific to proposed waiver amendments.

The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2010).

MSB 11-07-07-B Revision to the Medical Assistance rule Concerning Home and Community Based Services – Children’s Extensive Supports, Section 8.503

The rule implementing the HCBS Program for Children’s Extensive Supports, 10 C.C.R. 2505-10, Section 8.503 is being amended to incorporate the requirements of the existing HCBS Waiver, update language and plans for service that are out of date and includes language specific to proposed waiver amendments.

The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2010).

MSB 11-07-07-C Revision to the Medical Assistance rule Concerning Home and Community Based Services for Persons with Developmental Disabilities, Section 8.500

The rule implementing the HCBS for Persons with Developmental Disabilities Program, 10 C.C.R. 2505-10, Section 8.500 is being amended.

The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2006).

MSB 11-08-31-A Revision to the Medical Assistance Rule Concerning Pharmaceutical Reimbursement Methodology Change, Section 8.800.13

MSB 11-08-31-A. The statute regarding the Pharmaceutical Reimbursement Methodology Change will be presented at the September Medical Services Board meeting. Effective September 9, 2011, the rules for Pharmaceutical Reimbursement Calculation located at 10 C.C.R. 2505-10, Section 8.800.13 will be updated due to the changes in availability of information used to determine current rates.

“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