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 7 - HOME- AND COMMUNITY-BASED SERVICES FOR PERSONS WITH BRAIN INJURY (§§ 25.5-6-701 — 25.5-6-706) › Section 25.5-6-704 - [Effective Until 8/7/2024] Implementation of home- and community-based services program for persons with brain injury authorized - federal waiver - duties of the department - rules

(1)
(a)
The state department is hereby authorized to seek any necessary waiver from the federal government to develop and implement a home- and community-based services program for persons with brain injury. The state department shall design the program to provide home- and community-based services to eligible persons. Eligibility shall be limited to persons who meet the level of services provided in a hospital, rehabilitation hospital, hospital in lieu of nursing facility care, or who are in need of specialized care provided in a nursing facility in lieu of a hospital.
(b)
The state department shall seek any necessary amendments to the current federal waiver for the home- and community-based services program for persons with brain injury to allow supported living, as defined in section 25.5-6-703(8), to be provided to eligible persons on a supportive care campus.
(2)
Services for eligible persons may be established in department rules to the extent authorized or required by federal waiver, but must include at least the following:
(a)
Independent living skills training, as indicated in the eligible person's plan of care, and provided by local agencies determined by the department to be qualified to provide the services;
(b)
Residential care including, but not limited to:
(I)
Transitional living;
(II)
Respite care;
(III)
Supported living;
(c)
Personal care services;
(d)
Assisted transportation;
(e)
Counseling and training including treatment for substance use disorders and family counseling;
(f)
Environmental modification services;
(g)
Day care, which may include physical, occupational, and speech therapies as indicated in the eligible person's plan of care;
(h)
Structured day treatment, which may include physical, occupational, speech, and cognitive therapies if deemed necessary by the eligible person's case manager and as indicated in the person's plan of care. Structured day treatment services are for individuals who may benefit from continued rehabilitation and reintegration into the community.
(i)
Behavioral programming that may be provided in or outside an eligible person's residence;
(j)
Assistive technology;
(k)
Services provided under the consumer-directed care service model, part 11 of this article.
(3)
The case manager, in coordination with the eligible person and the person's family or guardian, shall include in each plan of care a process by which the eligible person may receive necessary care, which may include respite care, if the eligible person's family or service provider is unavailable due to an emergency situation or to unforeseen circumstances. The eligible person and the person's family or guardian shall be duly informed by the case manager of these alternative care provisions at the time the plan of care is initiated.
(4)
(a)
The department shall provide a system of reimbursement for services provided pursuant to this part 7 that encourages the most cost-effective provision of services.
(b)
A member of an eligible person's family, other than the person's spouse or a parent of a minor, may be employed to provide personal care services to such person. The maximum reimbursement for the services provided by a member of the person's family per year for an eligible person shall not exceed the equivalent of four hundred forty-four service units per year for a member of the eligible person's family. Standards that apply to other providers who provide personal care services apply to a family member who provides these services. In addition, a registered nurse shall supervise a family member in providing services to the extent indicated in the eligible person's plan of care.
(5)
The state department shall, subject to appropriation, use available federal, state, local, or private funds including, but not limited to, medicaid funds available under Title XIX of the federal "Social Security Act", as amended, to carry out the purposes of this part 7.
(6)
The state board shall adopt rules concerning the certification of agencies as medicaid providers for the purposes of this part 7, fiscal and administrative procedures, procedures for reviewing plans of care, reimbursement rates, and the scope, duration, and content of programs and the eligibility for specific services provided pursuant to this part 7. The state board shall adopt such rules as are necessary to fulfill the obligations of the state department as the single state agency to administer medical assistance programs in accordance with Title XIX of the federal "Social Security Act", as amended.
(7)
(a)
No later than January 2024, the state department shall submit a report to the senate health and human services committee, the house of representatives public and behavioral health and human services committee, and the house of representatives health and insurance committee, or any successor committees, as part of its "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" presentation required by section
2-7-203
. At a minimum, the report must identify:
(I)
A reimbursement system with a goal to incentivize and increase transportation provider participation;
(II)
How the state department will ensure compliance with applicable federal laws and waiver requirements;
(III)
A system of common reporting to ensure a recipient does not exceed the medicaid benefit in a multi-provider scenario; and
(IV)
Best practices based on what other states have done to allow transportation network companies to provide nonmedical transportation services for individuals receiving services, including but not limited to, reimbursement rates; driver compensation; and integration with programs that provide nonmedical transportation services.
(b)
In developing the report, the state department shall engage in a stakeholder process that includes individuals with intellectual and developmental disabilities and their families, individuals with disabilities, and transportation network companies. The report may be developed in conjunction with the reporting requirement in sections 25.5-6-307(6), 25.5-6-409(6), 25.5-6-606(9), and 25.5-6-1303(9).
(c)
(I)
Upon completion of the report described in subsection (7)(a) of this section, the state department shall analyze and review each operational transportation network company, as defined in section
40-10.1-602(3)
. The state department shall verify each transportation network company's viability to ensure the health, safety, welfare, cost effectiveness, and capability in expanding nonmedical transportation services for individuals receiving services pursuant to this section and comply with all rules promulgated pursuant to subsection (7)(e)(I) of this section.
(II)
No later than July 1, 2024, the state department shall authorize verified transportation network companies to provide nonmedical transportation services if the state department finds the transportation network company viable under federal requirements and within budgetary constraints.
(III)
For the purposes of this subsection (7)(c), "verify" means a transportation network company meets all requirements resulting from the report described in subsection (7)(a) of this section.
(d)
The state department may seek any necessary federal authorization for the implementation of this subsection (7).
(e)
(I)
The state department shall promulgate any necessary rules to ensure transportation network companies comply with federal and state oversight requirements and shall include all relevant stakeholders, including medicaid recipients, transportation network companies, current providers and drivers for nonmedical transportation services, and other interested parties in the development of such requirements.
(II)
Pursuant to section
40-10.1-105(1)(l)
, transportation network companies are not subject to regulation by the public utilities commission when providing nonmedical transportation services pursuant to this section and are instead subject to rules promulgated by the state department pursuant to this subsection (7)(e).
(f)
This subsection (7) does not apply to a provider authorized to provide transportation services pursuant to part 8 of article
1
of title
25.5
prior to August 10, 2022.
Amended by 2022 Ch. 396, § 5, eff. 8/10/2022.
Amended by 2017 Ch. 263, § 210, eff. 5/25/2017.
L. 2006: Entire article added with relocations, p. 1955, § 7, effective July 1. L. 2017: IP(2) and (2)(e) amended, (SB 17-242), ch. 263, p. 1330, § 210, effective May 25.
This section is similar to former § 26-4-684 as it existed prior to 2006.
2022 Ch. 396, 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 SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.