CO Code § 25.5-6-901 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 6 - Colorado Medical Assistance Act - Long-Term Care|Part 9 - Home- and Community-Based Service Programs for Children|§ 25.5-6-901. Disabled Children Care Program - Eligibility Criteria - Documentation Requirements - Report to the General Assembly

  The general assembly hereby finds and declares that a program shall be established by the state department to provide services not otherwise available to eligible disabled children outside the confines of an acute care hospital or nursing facility. Such program shall be known as the “disabled children care program” and shall be designed to safely provide services to eligible disabled children in a home- or community-based setting at a cost to the medicaid program equal to or less than the medicaid cost of inpatient hospital or nursing facility care.      The state department is authorized to seek a waiver from the federal department of health and human services to qualify for federal financial participation in the disabled children care program. Application for such waiver is contingent upon a finding that continuation of the disabled children care program results in less expenditures from the general fund than if such program were terminated.    If federal financial participation is secured, eligibility for participation in the program and the number of children to be served under the program shall be in accordance with federal regulations.         “Eligible disabled children” means any children eighteen years of age and under who:   Have medical needs which would qualify them, pursuant to state department criteria, for institutionalization or place them at risk for institutionalization in any one of the following: An acute care hospital or a nursing facility; and    Have gross incomes which do not exceed three hundred percent of the current federal supplemental security income benefit level. The amount of parental or spousal income and resources which shall be attributable to a child's gross income for purposes of eligibility shall be set forth in rules promulgated by the state board and shall be in relation to the parent's or spouse's financial responsibility for such child; and    Are not receiving services from any of the alternatives to long-term care waiver programs established under this title.       “Home care services” means all services available under sections 25.5-5-102, 25.5-5-103, 25.5-5-202, and 25.5-5-203 that may be received in a noninstitutional setting.         The state department shall require the following documentation on each applicant for the program:   An assessment by the disabled child's attending physician of the child's medical, functional, and social status and a determination by such physician that the quality of care which can be provided in the noninstitutional setting is equal to or exceeds the quality of care the child could receive in an acute care hospital or nursing facility;    An analysis of the cost of services for the disabled child in an institutional setting as compared to the cost of such services in a noninstitutional setting;    An assessment of the caregiver's ability to provide the needed services to the disabled child in a noninstitutional setting and an assessment of such caregiver's social history.       The information required under paragraph (a) of this subsection (4) shall be collected and reviewed by the state department at least every six months for disabled children who enter the disabled children care program in order to ensure that the quality of noninstitutional care continues to equal or exceed such care in an institutional setting and that the costs for care under the program are less than the costs for such care in an institution. When the disabled child is found to no longer qualify for institutionalization or be at risk for institutionalization pursuant to state department criteria, the child shall no longer be eligible for the disabled children care program.        History. Source: L. 2006: Entire article added with relocations, p. 1960, § 7, effective July 1.    Editor's note:   This section is similar to former § 26-4-509 as it existed prior to 2006.   ANNOTATION   Department did not err in considering child's medical need for hospital or nursing facility care when denying eligibility for home services waiver. The activities of daily living section of the long-term care client assessment is not determinative of eligibility based on medical need. Schlapp ex rel. Schlapp v. Dept. of Health, 2012 COA 105 , 284 P.3d 177.