2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 6 - COLORADO MEDICAL ASSISTANCE ACT - LONG-TERM CARE (§§ 25.5-6-101 — 25.5-6-2001) › Part 4 - HOME- AND COMMUNITY-BASED SERVICES FOR PERSONS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (§§ 25.5-6-401 — 25.5-6-413) › Section 25.5-6-406 - [Effective until 7/1/2025] Appropriations - reimbursement for services - direct support professionals - legislative declaration - definitions

(1)
To carry out duties and obligations pursuant to this part 4 and for the administration and provision of services to eligible persons, all medicaid funds appropriated pursuant to Title XIX of the federal "Social Security Act", as amended, for the provision of care for persons with developmental disabilities and all other funds otherwise appropriated by the general assembly as additional sources of program funding are available for the placement of eligible persons either in intermediate care facilities for persons with intellectual disabilities or alternatives to such placements.
(2)
(a)
(I)
The general assembly finds and declares that:
(A)
Colorado's system of home- and community-based services that supports Coloradans with intellectual and developmental disabilities has grown to serve more than twelve thousand persons and their families;
(B)
Costs associated with providing these services continue to rise with growth in demand, inflation, increased regulation, rising minimum wages, rising health-care costs, and other economic factors;
(C)
Reimbursement rates have not kept pace with these rising costs, resulting in reduced access to services for Coloradans with intellectual and developmental disabilities;
(D)
Colorado needs significant initial investments to address the most urgent issues concerning services for persons with intellectual and developmental disabilities, as well as future long-term planning to address the growing strain on the system;
(E)
One of the most urgent issues is the workforce crisis among direct support professionals, characterized by chronically low wages, limited benefits, and lack of career advancement opportunities for these critical workers;
(F)
Colorado is experiencing a workforce crisis among direct support professionals because reimbursement rates cannot support the compensation needed to match the high level of responsibility required in these jobs;
(G)
Agencies that serve people with intellectual and developmental disabilities increasingly struggle to recruit and retain direct support professionals to meet the demand for services; and
(H)
High turnover among direct support professionals results in reduced continuity of services for persons with intellectual and developmental disabilities.
(II)
Therefore, as an initial investment, Colorado's reimbursement rates should be increased to allow for direct support professional compensation that better reflects market realities and the high level of responsibility required in these jobs.
(b)
As used in this subsection (2), unless the context otherwise requires:
(I)
"Compensation" means any form of monetary payment, including bonuses, employer-paid health and other insurance programs, paid time off, payroll taxes, and all other fixed and variable benefits conferred on or received by a direct support professional.
(II)
"Direct support professional" means a worker who assists or supervises a worker to assist a person with intellectual and developmental disabilities to lead a fulfilling life in the community through a diverse range of services, including helping the person get ready in the morning, take medication, go to work or find work, and participate in social activities. "Direct support professional" includes all workers categorized as program direct support professionals and excludes workers categorized as administrative, as defined in standards established by the Financial Accounting Standards Board.
(c)
The state department shall immediately seek a six and one-half percent increase in the reimbursement rate for the following services delivered through the home- and community-based services for persons with developmental disabilities, supported living services, and children's extensive supports waivers:
(I)
Group residential services and supports;
(II)
Individual residential services and supports;
(III)
Specialized habilitation;
(IV)
Respite;
(V)
Homemaker basic;
(VI)
Homemaker enhanced;
(VII)
Personal care;
(VIII)
Prevocational services;
(IX)
Behavioral line staff;
(X)
Community connector;
(XI)
Supported community connections;
(XII)
Mentorship;
(XIII)
Supported employment - job development; and
(XIV)
Supported employment - job coaching.
(d)
The state department shall implement a corresponding increase in service plan authorization limits to account for this increase in reimbursement rates.
(e)
Service agencies shall use one hundred percent of the funding resulting from the increase in the reimbursement rate pursuant to subsection (2)(c) of this section to increase compensation for direct support professionals above the rate of compensation that direct support professionals are receiving as of June 30, 2018. This requirement applies to funds billed by case management agencies and entities in their role as organized health-care delivery systems, as defined in
42 CFR 447.10(b)
. Service agencies shall not use funding resulting from the reimbursement rate increase for general and administrative expenses, such as chief executive officer salaries, human resources, information technology, oversight, business management, general record keeping, budgeting and finance, and other activities not identifiable to a single program.
(f)
(I)
For the 2018-19 through 2020-21 fiscal years, service agencies shall track how they used the funding resulting from the increase in the reimbursement rate pursuant to subsection (2)(c) of this section using a reporting tool developed by the state department in collaboration with service agencies. On or before December 31, 2019, service agencies shall submit the report to the state department demonstrating how the funding was used to increase direct support professional compensation for the 2018-19 fiscal year. The state department shall have ongoing discretion to request information from service agencies demonstrating how they maintained increases in compensation for direct support professionals beyond the three-year tracking period.
(II)
Service agencies shall maintain all books, documents, papers, accounting records, and other evidence required to support the tracking of payroll information for increased compensation to direct support professionals pursuant to subsection (2)(f)(I) of this section for at least three years from the end of each respective fiscal year. Service agencies shall make the information and materials available for inspection by the state department or its designees at all reasonable times.
(g)
If a service agency does not use one hundred percent of the funding resulting from the increase in the reimbursement rate pursuant to subsection (2)(c) of this section to increase compensation for direct support professionals, the state department may recoup part or all of the funding resulting from the increase in the reimbursement rate.
(h)
If the state department determines that the service agency did not use the funding resulting from the increase in the reimbursement rate pursuant to subsection (2)(c) of this section as required, within one year after the end of each fiscal year described in subsection (2)(f)(I) of this section, the state department shall notify the service agency in writing of the state department's intention to recoup funds pursuant to subsection (2)(g) of this section.
(i)
The service agency has forty-five days after receiving notice of the determination under subsection (2)(h) of this section to:
(I)
Challenge the determination of the state department;
(II)
Provide additional information to the state department demonstrating compliance; or
(III)
Submit a plan of correction to the state department.
(j)
The state department shall notify the service agency in writing of its final determination after affording the service agency the opportunity to take the actions specified in subsection (2)(i) of this section.
(k)
The state department shall recoup from a service agency one hundred percent of the funding resulting from the increase in the reimbursement rate pursuant to subsection (2)(c) of this section that the service agency received but did not use for compensation for direct support professionals if:
(I)
The service agency fails to respond to a notice of determination of the state department within the time provided in subsection (2)(i) of this section;
(II)
The service agency is unable to provide documentation of compliance; or
(III)
The state department does not accept the plan of correction submitted by the service agency pursuant to subsection (2)(i) of this section.
(l)
The state department shall participate in the national core indicators staff stability survey.
(m)
Once the state department determines that a sufficient quantity and quality of data exists to determine the impact and outcomes, if any, attributed to the increase in the reimbursement rate pursuant to subsection (2)(c) of this section on persons with intellectual and developmental disabilities, the state department shall include in its annual report concerning the waiting list for services and supports for persons with intellectual and developmental disabilities, required pursuant to section 25.5-10-207.5, information from the national core indicators data, or another comparable source, concerning in what ways outcomes for persons with intellectual and developmental disabilities changed as a result of the increase in reimbursement rates pursuant to subsection (2)(c) of this section. The report must include, if available, multiyear personal outcome data specific to Colorado and comparisons to other states, as appropriate, as well as data from the national core indicators staff stability survey.
Amended by 2021 Ch. 83, § 32, eff. 7/1/2024.
Amended by 2020 Ch. 204, § 1, eff. 6/30/2020.
Amended by 2018 Ch. 248, § 2, eff. 5/24/2018.
Amended by 2013 Ch. 394, § 6, eff. 6/5/2013.
L. 2006: Entire article added with relocations, p. 1945, § 7, effective July 1. L. 2013: Entire section amended, (SB 13-167), ch. 2294, p. 2294, § 6, effective June 5. L. 2018: Entire section amended, (HB 18-1407), ch. 1527, p. 1527, § 2, effective May 24. L. 2020: (2)(f) and (2)(h) amended, (HB 20-1363), ch. 1007, p. 1007, § 1, effective June 30. L. 2021: (2)(e) amended, (HB 21 -1187), ch. 334, p. 334, § 32, effective 7/1/2024.
This section is similar to former § 26-4-626 as it existed prior to 2006.
2021 Ch. 83, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.
For the legislative declaration in HB 18-1407, see section 1 of chapter 248, Session Laws of Colorado 2018.