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 Susan E. Birch, MBA, BSN, RN, Executive Director

May 30, 2014

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 July 2014 meeting of the Medical Services Board of the Department of Health Care Policy and Financing. The meeting will be held on Friday, July 11, 2014, beginning at 9:00 A.M., in the seventh floor conference room at the 303 East 17th 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

July 11, 2014 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, July 11, 2014, beginning at 9:00 a.m., in the seventh floor conference room at the 303 East 17th 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 HCPF:+Meeting Schedule.

MSB 14-04-21-A. Revision to the Medical Assistance Pharmacy Section Rule Concerning Durable Medical Equipment and Disposable Medical Supplies Provider Rate Increase, Section 8.590.7.I

Medical Assistance. DME and Supplies. Effective July 1, 2014, reimbursement rates will be raised by 2% to account for General Assembly funding appropriation. The Medical Assistance Rule concerning Durable Medical Equipment and Disposable Medical Supplies, 10 C.C.R. 2505-10, Section 8.590.7.I, is being revised to reflect the provider reimbursement rate increase per HB 14-1336. The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2013).

MSB 14-04-21-B. Revision to the Medical Assistance Rates Section Rule Concerning Payments for Outpatient Hospital Services, Section 8.300.6

Medical Assistance. Outpatient Hospital Services. Reimbursement for Medicaid outpatient hospitals services was increased by 2 percent (2%) pursuant to the FY 2014-15 Long Appropriations Bill, House Bill 14-1336, Therefore, the rules for the reimbursement for outpatient hospital services, 10 C.C.R. 2505-10 Section 8.300.6 are being revised to include the increased reimbursement effective July 1, 2014. The authority for this rule is contained in 24-4-103(6), 25.5-1-301 through 25.5-1-303, C.R.S. (2013).

MSB 14-04-21-C. Revision to the Medical Assistance Rates Section Rule Concerning Encounter Rate Calculation, Section 8.700.6.C

Medical Assistance. The purpose of this rule is to restore the alternative payment rate for FQHCs. It will remove the midpoint calculation between the PPS rate and the alternative payment rate in in the FQHC encounter rate. The rate increase will not exceed the alternative payment rate (APM). The authority for this rule is contained in 24-4-103(6), 25.5-1-301 through 25.5-1-303, C.R.S. (2013).

MSB 14-06-02-A, Revision to the Medical Assistance Health Programs Services and Supports Rule Concerning Dental Services, Section 8.201

Medical Assistance. The Joint Budget Committee authorized funding for complete dentures during the 2014 legislative session. The appropriation included approximately $26.8 million total funds--approximately $5.9 million from the Adult Dental Fund and $87,874 from the Hospital Provider Fee Cash Fund.

The purpose of this rule change is to add dentures to our existing rules regarding Dental Services. The specific unit limits were developed through the Benefits Collaborative Process and with the input/advice from our consultants and other key stakeholders such as the Colorado Dental Association. This benefit will be subject to prior authorization and will not be subject to the $1,000 annual maximum for Dental Services.

The authority for this rule is contained in §§ 25.5-1-301-303, C.R.S. (2013); § 25.5-5-201(1)(w), C.R.S. (2013), 25.5-1-301 through 25.5-1-303, C.R.S. (2013).

MSB 13-12-20-A. Revision to the Medical Assistance Health Programs Service and Support Rule Concerning the Program of All-Inclusive Care for the Elderly, Section 8.497

Medical Assistance. The statute authorizing the Program of All-Inclusive Care for the Elderly (PACE), Section 25.5-5-412, C.R.S. was modified pursuant to SB 12-023. Therefore, rules implementing aspects of the program, have been added to account for those changes.

This rule change adds two provisions:

1) To allow Medicaid clients that are eligible for PACE but enrolled in a managed care organization, RCCO, or other risk based entity to disenroll and enroll in PACE (if a client chooses to do so); and

2) To allow PACE organizations to contract with an enrollment broker to include information on PACE in the enrollment broker's marketing materials to eligible long-term care clients.

The authority for this rule is contained in 24-4-103(6), 25.5-1-301 through 25.5-1-303, C.R.S. (2013).

“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