CO Code § 25.5-6-203 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 6 - Colorado Medical Assistance Act - Long-Term Care|Part 2 - Nursing Facilities|§ 25.5-6-203. Nursing Facilities - Provider Fees - Federal Waiver - Fund Created - Rules - Repeal

      Beginning with the fiscal year commencing July 1, 2008, and each fiscal year thereafter, the state department shall charge and collect provider fees on health-care items or services provided by nursing facility providers for the purpose of obtaining federal financial participation under the state's medical assistance program as described in articles 4 to 6 of this title. As specified by the priority of the uses of the provider fee in paragraph (b) of subsection (2) of this section, the provider fees shall be used to sustain or increase reimbursement for providing medical care under the state's medical assistance program for nursing facility providers. (a) (I)Beginning with the fiscal year commencing July 1, 2008, and each fiscal year thereafter, the state department shall charge and collect provider fees on health-care items or services provided by nursing facility providers for the purpose of obtaining federal financial participation under the state's medical assistance program as described in articles 4 to 6 of this title. As specified by the priority of the uses of the provider fee in paragraph (b) of subsection (2) of this section, the provider fees shall be used to sustain or increase reimbursement for providing medical care under the state's medical assistance program for nursing facility providers.    For the fiscal years commencing July 1, 2009, and July 1, 2010, the provider fee shall not exceed seven dollars and fifty cents per nonmedicare-resident day. For the fiscal year commencing July 1, 2011, and each fiscal year thereafter, the provider fee shall not exceed twelve dollars per nonmedicare-resident day plus inflation based on the national skilled nursing facility market basket index as determined by the secretary of the department of health and human services pursuant to 42 U.S.C. sec. 1395yy (e)(5) or any successor index.    In calculating the amount of the provider fee portion of the supplemental medicaid payments established under section 25.5-6-202 (5), the state department may include an additional amount of up to five percent of the provider fee portion of said supplemental medicaid payments to initiate the payment to any provider who complies with the established performance measures during the state fiscal year.       The provider fees shall be charged on a nonmedicare-resident day basis and shall be based upon the aggregate gross or net revenue, as prescribed by the state department, of all nursing facility providers subject to the provider fee. The state department may exempt revenue categories from the gross or net revenue calculation and the collection of the provider fee from nursing facility providers, as authorized by federal law.    In accordance with the redistributive method set forth in 42 CFR 433.68 (e)(1) and (e)(2), the state department shall seek a waiver from the broad-based provider fees requirement or the uniform provider fees requirement, or both, to exclude nursing facility providers from the provider fee. The state department shall exempt the following nursing facility providers to obtain federal approval and minimize the financial impact on nursing facility providers:   A facility operated as a continuing care retirement community that provides a continuum of services by one operational entity providing independent living services, assisted living services, and skilled nursing care on a single, contiguous campus. Assisted living services include an assisted living residence as defined in section 25-27-102, C.R.S., or that provides assisted living services on-site, twenty-four hours per day, seven days per week.    A skilled nursing facility owned and operated by the state;    A nursing facility that is a distinct part of a facility that is licensed as a general acute care hospital; and    A facility that has forty-five or fewer licensed beds.       The state department may lower the amount of the provider fee charged to certain nursing facility providers to meet the requirements of 42 CFR 433.68 (e) and to obtain federal approval.    The imposition and collection of a provider fee shall be prohibited without the federal government's approval of a state medicaid plan amendment authorizing federal financial participation for the provider fees. The state department may alter the method prescribed in this section to the extent necessary to meet the federal requirements and to obtain federal approval.    If the provider fee required by this subsection (1) is not approved by the federal government, notwithstanding any other provision of this section, the state department shall not implement the assessment or collection of the provider fee from nursing facility providers.    The state department shall establish a schedule to assess and collect the provider fee on a monthly basis. The state board shall establish rules so that provider fee payments from a nursing facility provider and the state department's supplemental medicaid payments to the nursing facility are due as nearly simultaneously as feasible; except that the state department's supplemental medicaid payments to the nursing facility shall be due no more than fifteen days after the provider fee payment is received from the nursing facility. The state department shall require each nursing facility provider to report annually its total number of days of care provided to nonmedicare residents.    The state department shall not assess or collect the provider fee until state medicaid plan amendments adopting the medicaid reimbursement system for the state's class I nursing facility providers, pursuant to section 25.5-6-202, including the waiver with respect to the provider fees pursuant to this section, have been approved by the federal government.    The state board shall promulgate any rules pursuant to the “State Administrative Procedure Act”, article 4 of title 24, C.R.S., necessary for the administration and implementation of this section.    A nursing facility provider shall not include any amount of the provider fee as a separate line item in its billing statements.         All provider fees collected pursuant to this section by the state department shall be transmitted to the state treasurer, who shall credit the same to the medicaid nursing facility cash fund, which fund is hereby created and referred to in this section as the “fund”.      All moneys in the fund shall be subject to federal matching as authorized under federal law and subject to annual appropriation by the general assembly for the purpose of paying the administrative costs of implementing section 25.5-6-202 and this section, to satisfy settlements or judgments resulting from nursing facility provider reimbursement appeals, and to pay the supplemental medicaid payments to offset payment of the provider fee established under section 25.5-6-202 (7). (b) (I) All moneys in the fund shall be subject to federal matching as authorized under federal law and subject to annual appropriation by the general assembly for the purpose of paying the administrative costs of implementing section 25.5-6-202 and this section, to satisfy settlements or judgments resulting from nursing facility provider reimbursement appeals, and to pay the supplemental medicaid payments to offset payment of the provider fee established under section 25.5-6-202 (7).    Following the payment of the amounts described in subparagraph (I) of this paragraph (b), the moneys remaining in the fund shall be subject to federal matching as authorized under federal law and subject to annual appropriation by the general assembly for the purpose of paying the supplemental medicaid payments for acuity or case-mix of residents established under section 25.5-6-202 (2).    (A) Except as provided in sub-subparagraph (B) of this subparagraph (III), after the payment of the amounts described in subparagraphs (I) and (II) of this paragraph (b), the moneys remaining in the fund shall be subject to federal matching as authorized under federal law and subject to annual appropriation by the general assembly for the purpose of paying the supplemental medicaid payments for higher quality performance established under section 25.5-6-202 (5).    Following the payment of the amounts described in subsections (2)(b)(I) to (2)(b)(III) of this section, the money remaining in the fund shall be subject to federal matching as authorized under federal law and subject to annual appropriation by the general assembly for the purpose of paying the supplemental medicaid payments established under section 25.5-6-202 (6) for residents who have moderately to very severe mental health conditions, dementia diseases and related disabilities, or acquired brain injury.    Following the payment of the amounts described in subparagraphs (I) to (IV) of this paragraph (b), the moneys remaining in the fund shall be subject to federal matching as authorized under federal law and subject to annual appropriation by the general assembly for the purpose of paying the supplemental medicaid payments for the amount by which the average statewide per diem rate exceeds the general fund share established under section 25.5-6-202 (9)(b)(II).    Any moneys in the fund not expended for the purposes specified in this section may be invested by the state treasurer as provided by law. All interest and income derived from the investment and deposit of moneys in the fund shall be credited to the fund. Any unexpended and unencumbered moneys remaining in the fund at the end of any fiscal year shall remain in the fund and shall not be credited or transferred to the general fund or any other fund but may be appropriated by the general assembly to pay nursing facility providers in future fiscal years.    (A) Notwithstanding any other provision of this subsection (2)(b), for state medicaid expenditures for state fiscal years 2019-20, 2020-21, and any subsequent fiscal years, as long as the increased reimbursements and payments pursuant to the federal “Families First Coronavirus Response Act”, Pub.L. 116-127, are still available only, and regardless of when this federal money is made available, money in the fund may be used to offset general fund expenditures in the medicaid program in an equivalent amount that would have been in excess of the fifty percent federal financial participation generated by increased reimbursements and payments appropriated for use in subsections (2)(b)(I) to (2)(b)(V) of this section pursuant to the federal“Families First Coronavirus Response Act”, Pub.L. 116-127, or any amendment thereto, or any other federal law that increases federal financial participation above the federal financial participation percentage in effect prior to the increase in federal financial participation provided through the federal“Families First Coronavirus Response Act”. The state treasurer shall transfer such amount to the general fund for the state medicaid program.           History. Source: L. 2006: Entire article added with relocations, p. 1926, § 7, effective July 1. L. 2008: Entire section R&RE, p. 1781, § 4, effective July 1. L. 2009: (1)(a), (1)(g), and (2)(b) amended and (1)(j) added,(SB 09-263), ch. 203, p. 918, § 3, effective May 1; (1)(c)(I) amended,(SB 09-292), ch. 369, p. 1975, § 98, effective August 5. L. 2010: (2)(b)(II.7) added,(HB 10-1324), ch. 14, p. 69, § 2, effective March 1. L. 2011: (1)(a)(II) and (2) amended,(SB 11-125), ch. 208, p. 900, § 1, effective August 10. L. 2013: (1)(c)(I) and (1)(g) amended,(HB 13-1199), ch. 63, p. 209, § 2, effective March 22. L. 2014: (2)(b)(I) amended,(SB 14-143), ch. 191, p. 712, § 1, effective May 15. L. 2018: (2)(b)(IV) amended,(HB 18-1091), ch. 74, p. 644, § 6, effective August 8. L. 2020: (2)(b)(VII) added,(HB 20-1385), ch. 173, p. 797, § 3, effective June 29. L. 2021: (2)(b)(VII) amended,(SB 21-213), ch. 88, p. 365, § 3, effective May 4.    Editor's note:   This section is similar to former § 26-4-503 as it existed prior to 2006.   Cross references:   For the legislative declaration contained in the 2008 act amending this section, see section 1 of chapter 383, Session Laws of Colorado 2008. For the legislative declaration in the 2013 act amending subsections (1)(c)(I) and (1)(g), see section 1 of chapter 63, Session Laws of Colorado 2013.