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Second Regular Session
Seventy-fifth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 26-0051.02 Chelsea Princell x4335 HOUSE BILL 26-1018
House Committees Senate Committees
Health & Human Services
A BILL FOR AN ACT
CONCERNING THE ESTABLISHMENT OF LONG -TERM SERVICES AND101
SUPPORTS FOR AN INDIVIDUAL TRANSITIONING OUT OF A102
NURSING FACILITY.103
Bill Summary
(Note: This summary applies to this bill as introduced and does
not reflect any amendments that may be subsequently adopted. If this bill
passes third reading in the house of introduction, a bill summary that
applies to the reengrossed version of this bill will be available at
http://leg.colorado.gov.)
The bill requires an individual being discharged from a nursing
facility to be presumptively eligible for long-term services and supports
under medicaid.
The bill requires the department of health care policy and
financing (state department) to determine presumptive eligibility and
HOUSE SPONSORSHIP
Jackson and Joseph,
SENATE SPONSORSHIP
Amabile,
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law.
requires county departments of human or social services (county
departments) to set up the long-term services and supports for an
individual being discharged from a nursing facility prior to the
individual's discharge date.
The state department is required to submit an annual report to the
state auditor and post the report on the state department's website
detailing information about the individuals discharged from a nursing
facility and the associated presumptive eligibility determinations.
The bill establishes remedial measures against a county department
if the county department fails to set up long-term services and supports
for the individual. The bill establishes remedial measures against a
nursing facility that fails to discharge an individual on the discharge date
due to a failure within the nursing facility's control or fails to cooperate
in good faith with the state department to ensure long-term care services
and supports are in place for the individual.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, add 25.5-6-315 as2
follows:3
25.5-6-315. Long-term services and supports for nursing4
facility residents - discharge planning - presumptive eligibility -5
reporting - definition.6
(1) AS USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE7
REQUIRES, "PRESUMPTIVE ELIGIBILITY" HAS THE MEANING SET FORTH IN8
SECTION 25.5-5-204.9
(2) (a) I F THE STATE DEPARTMENT RECEIVES FEDERAL10
AUTHORIZATION PURSUANT TO SECTION 25.5-5-204 (2.7) AND , AS11
NECESSARY, SUBSECTION (15) OF THIS SECTION , AN INDIVIDUAL BEING12
DISCHARGED FROM A NURSING FACILITY IS PRESUMPTIVELY ELIGIBLE FOR13
THE MEDICAL ASSISTANCE PROGRAM PURSUANT TO THIS ARTICLE 6 AND14
ARTICLES 4 AND 5 OF THIS TITLE 25.5 TO RECEIVE LONG-TERM SERVICES15
AND SUPPORTS , INCLUDING HOME - AND COMMUNITY -BASED SERVICES ,16
PURSUANT TO THIS ARTICLE 6 IF THE INDIVIDUAL:17
HB26-1018-2-
(I) I S FUNCTIONALLY ELIGIBLE FOR LONG -TERM SERVICES AND1
SUPPORTS PURSUANT TO THIS ARTICLE 6; AND2
(II) ATTESTS TO INFORMATION THAT MEETS THE INCOME, ASSETS,3
AND IMMIGRATION ELIGIBILITY REQUIREMENTS FOR THE MEDICAL4
ASSISTANCE PROGRAM.5
(b) THE ATTESTATION REQUIRED BY SUBSECTION (2)(a)(II) OF THIS6
SECTION MUST BE MADE TO THE STATE DEPARTMENT IN THE MANNER7
PRESCRIBED BY THE STATE DEPARTMENT AT THE TIME OF THE FUNCTIONAL8
ELIGIBILITY ASSESSMENT REQUIRED IN SUBSECTION (4) OF THIS SECTION.9
(3) A NURSING FACILITY SHALL NOTIFY THE STATE DEPARTMENT10
WITHIN THREE BUSINESS DAYS OF AN INDIVIDUAL WHO IS ELIGIBLE TO11
TRANSITION OUT OF A NURSING FACILITY AFTER DETERMINING THE12
INDIVIDUAL'S ELIGIBILITY TO TRANSITION OUT OF THE NURSING FACILITY.13
(4) (a) T HE STATE DEPARTMENT MUST ASSESS AN INDIVIDUAL14
BEING DISCHARGED FROM A NURSING FACILITY TO DETERMINE WHETHER15
THE INDIVIDUAL IS FUNCTIONALLY ELIGIBLE FOR LONG -TERM SERVICES16
AND SUPPORTS PURSUANT TO THIS ARTICLE 6 WITHIN ONE BUSINESS DAY17
AFTER RECEIVING NOTIFICATION THAT THE INDIVIDUAL IS ELIGIBLE TO18
TRANSITION OUT OF A NURSING FACILITY . A FUNCTIONAL ELIGIBILITY19
DETERMINATION MUST BE MADE BEFORE HOUSING IS SECURED FOR THE20
INDIVIDUAL.21
(b) IF THE STATE DEPARTMENT DETERMINES THAT AN INDIVIDUAL22
IS FUNCTIONALLY ELIGIBLE FOR LONG -TERM SERVICES AND SUPPORTS23
PURSUANT TO THIS ARTICLE 6 AND SUBSECTION (4)(a) OF THIS SECTION,24
AND THE INDIVIDUAL COMPLETED THE ATTESTATION REQUIRED IN25
SUBSECTION (2)(a)(II) OF THIS SECTION, THE STATE DEPARTMENT SHALL26
DETERMINE THAT THE INDIVIDUAL IS PRESUMPTIVELY ELIGIBLE TO27
HB26-1018-3-
RECEIVE LONG -TERM SERVICES AND SUPPORTS PURSUANT TO THIS1
SECTION. THE STATE DEPARTMENT SHALL NOTIFY THE COUNTY2
DEPARTMENT THAT THE INDIVIDUAL IS PRESUMPTIVELY ELIGIBLE.3
(c) U PON RECEIPT OF THE PRESUMPTIVE ELIGIBILITY4
DETERMINATION MADE PURSUANT TO SUBSECTION (4)(b) OF THIS SECTION5
AND WITHIN THREE BUSINESS DAYS AFTER RECEIVING THE NOTIFICATION,6
THE COUNTY DEPARTMENT MUST ENROLL THE INDIVIDUAL IN LONG-TERM7
SERVICES AND SUPPORTS THAT MEET THE INDIVIDUAL 'S NEEDS . THE8
COUNTY DEPARTMENT SHALL NOT ENGAGE IN A FINANCIAL ELIGIBILITY9
DETERMINATION FOR THE INDIVIDUAL.10
(5) THE INDIVIDUAL OR THE INDIVIDUAL'S LEGAL REPRESENTATIVE11
MUST SUBMIT AN APPLICATION FOR LONG-TERM SERVICES AND SUPPORTS12
TO THE STATE DEPARTMENT WITHIN TEN CALENDAR DAYS AFTER THE13
PRESUMPTIVE ELIGIBILITY DETERMINATION.14
(6) I F AN INDIVIDUAL BEING DISCHARGED FROM A NURSING15
FACILITY IS DETERMINED TO BE PRESUMPTIVELY ELIGIBLE FOR SERVICES16
THROUGH A LONG -TERM CARE PROGRAM PURSUANT TO THIS ARTICLE 6,17
ANY PRIOR AUTHORIZATION REQUIRED FOR A SERVICE PROVIDER TO BILL18
FOR HOME HEALTH SERVICES RENDERED TO THE INDIVIDUAL MUST BE19
APPROVED BY THE STATE DEPARTMENT , AND THE NECESSARY SERVICES20
MUST BE IN PLACE PRIOR TO THE INDIVIDUAL'S DATE OF DISCHARGE FROM21
THE NURSING FACILITY.22
(7) A FTER PRESUMPTIVE ELIGIBILITY IS DETERMINED FOR AN23
INDIVIDUAL, THE NURSING FACILITY MUST WORK WITH ALL APPROPRIATE24
ENTITIES TO ENSURE THE LONG-TERM SERVICES AND SUPPORTS THAT THE25
INDIVIDUAL REQUIRES ARE IN PLACE PRIOR TO THE INDIVIDUAL'S DATE OF26
DISCHARGE FROM THE NURSING FACILITY.27
HB26-1018-4-
(8) THE PRESUMPTIVE ELIGIBILITY PERIOD BEGINS ON THE DATE1
THE INDIVIDUAL IS DETERMINED FUNCTIONALLY ELIGIBLE FOR LONG-TERM2
SERVICES AND SUPPORTS PURSUANT TO THIS ARTICLE 6 AND SUBSECTION3
(4)(a) OF THIS SECTION AND ENDS ON THE LATER OF:4
(a) THE LAST DAY OF THE MONTH FOLLOWING THE MONTH OF THE5
PRESUMPTIVE ELIGIBILITY DETERMINATION IF A LONG-TERM SERVICE AND6
SUPPORT APPLICATION IS NOT COMPLETED AND SUBMITTED PURSUANT TO7
SUBSECTION (5) OF THIS SECTION WITHIN TEN CALENDAR DAYS AFTER THE8
PRESUMPTIVE ELIGIBILITY DETERMINATION; OR9
(b) T HE LAST DAY OF THE MONTH THAT FINAL ELIGIBILITY10
DETERMINATION IS MADE IF A LONG -TERM SERVICE AND SUPPORT11
APPLICATION IS SUBMITTED PURSUANT TO SUBSECTION (5) OF THIS12
SECTION WITHIN TEN CALENDAR DAYS AFTER THE PRESUMPTIVE13
ELIGIBILITY DETERMINATION.14
(9) IF IT IS DETERMINED THAT AN INDIVIDUAL IS NOT ELIGIBLE FOR15
MEDICAL BENEFITS AFTER THE INDIVIDUAL WAS DETERMINED TO BE16
ELIGIBLE FOR SERVICES THROUGH A LONG -TERM CARE PROGRAM17
PURSUANT TO THIS ARTICLE 6 BASED ON PRESUMPTIVE ELIGIBILITY, THE18
STATE DEPARTMENT SHALL NOT PURSUE RECOVERY FROM A COUNTY19
DEPARTMENT FOR THE COST OF MEDICAL SERVICES PROVIDED TO THE20
INDIVIDUAL. THE COUNTY DEPARTMENT IS NOT RESPONSIBLE FOR ANY21
FEDERAL ERROR RATE SANCTIONS RESULTING FROM THE DETERMINATION.22
(10) REDETERMINATION OF ELIGIBILITY FOR MEDICAL ASSISTANCE23
MUST TAKE PLACE ANNUALLY ON THE DATE THE MEMBER WAS INITIALLY24
ENROLLED IN THE STATE MEDICAL ASSISTANCE PROGRAM.25
(11) O N OR BEFORE JANUARY 1, 2028, AND EACH JANUARY 126
THEREAFTER, THE STATE DEPARTMENT SHALL SUBMIT A REPORT TO THE27
HB26-1018-5-
STATE AUDITOR AND POST THE REPORT ON THE STATE DEPARTMENT 'S1
WEBSITE DETAILING THE FOLLOWING FOR THE PREVIOUS CALENDAR YEAR:2
(a) THE NUMBER OF INDIVIDUALS DISCHARGED FROM A NURSING3
FACILITY WHO WERE DETERMINED TO BE PRESUMPTIVELY ELIGIBLE FOR4
LONG-TERM SERVICES AND SUPPORTS AS DESCRIBED IN THE STATE5
MEDICAL ASSISTANCE PROGRAM ESTABLISHED PURSUANT TO THIS ARTICLE6
6 AND ARTICLES 4 AND 5 OF THIS TITLE 25.5;7
(b) H OW LONG IT TOOK FOR EACH PRESUMPTIVE ELIGIBILITY8
DETERMINATION TO BE MADE;9
(c) HOW LONG IT TOOK TO DETERMINE FUNCTIONAL ELIGIBILITY10
AND FINANCIAL ELIGIBILITY FOR EACH INDIVIDUAL;11
(d) FOR EACH INDIVIDUAL, THE NUMBER OF DAYS BETWEEN WHEN12
THE STATE DEPARTMENT NOTIFIED THE COUNTY DEPARTMENT THAT THE13
INDIVIDUAL WAS FUNCTIONALLY ELIGIBLE FOR LONG-TERM SERVICES AND14
SUPPORTS AND WHEN THE COUNTY DEPARTMENT ENROLLED THE15
INDIVIDUAL IN LONG-TERM SERVICES AND SUPPORTS;16
(e) THE NUMBER OF INDIVIDUALS WHO WERE DETERMINED TO BE17
PRESUMPTIVELY ELIGIBLE FOR LONG-TERM SERVICES AND SUPPORTS AND18
DISCHARGED FROM A NURSING FACILITY WITHOUT LONG-TERM SERVICES19
AND SUPPORTS IN PLACE AND THE REASON THAT THE NECESSARY SERVICES20
AND SUPPORTS WERE NOT IN PLACE AT THE TIME OF THE INDIVIDUAL 'S21
DISCHARGE FROM THE NURSING FACILITY; AND22
(f) A LIST OF LOCAL SUPPORT AGENCIES, INCLUDING ANY OF THE23
STATE-CONTRACTED INDEPENDENT LIVING CENTERS , AREA AGENCY ON24
AGING CENTERS , OR OTHER COMMUNITY SUPPORT AGENCIES , THAT25
PROVIDE SERVICES TO THE ELDERLY, BLIND, OR DISABLED COMMUNITY.26
(12) U PON RECEIPT OF THE REPORT SUBMITTED PURSUANT TO27
HB26-1018-6-
SUBSECTION (11) OF THIS SECTION, THE STATE AUDITOR MAY CONDUCT AN1
AUDIT OF THE STATE DEPARTMENT FOR ANY DELAY DETAILED IN THE2
REPORT THAT RESULTED IN AN INDIVIDUAL BEING DISCHARGED FROM A3
NURSING FACILITY WITHOUT LONG -TERM SERVICES AND SUPPORTS IN4
PLACE.5
(13) I F A COUNTY DEPARTMENT FAILS THREE TIMES WITHIN A6
CALENDAR YEAR TO ENROLL AN INDIVIDUAL IN LONG-TERM SERVICES AND7
SUPPORTS WITHIN THREE BUSINESS DAYS AFTER RECEIVING NOTIFICATION8
FROM THE STATE DEPARTMENT AS REQUIRED BY SUBSECTION (3)(c) OF9
THIS SECTION , THE STATE DEPARTMENT MAY TRANSFER THE10
RESPONSIBILITY TO ANOTHER AGENCY OR VENDOR.11
(14) (a) I F A NURSING FACILITY FAILS TO DISCHARGE AN12
INDIVIDUAL ON THE DATE OF DISCHARGE DUE TO A FAILURE WITHIN THE13
NURSING FACILITY'S CONTROL OR FAILS TO COOPERATE IN GOOD FAITH14
WITH THE STATE DEPARTMENT TO ENSURE LONG -TERM CARE SERVICES15
AND SUPPORTS ARE IN PLACE FOR THE INDIVIDUAL ON THE INDIVI DUAL'S16
DATE OF DISCHARGE , THE STATE DEPARTMENT MAY ISSUE A BILLING17
PENALTY RESULTING IN THE NURSING FACILITY'S INABILITY TO BILL THE18
MEDICAL ASSISTANCE PROGRAM FOR UP TO A MAXIMUM OF SEVEN19
CALENDAR DAYS FOR THE SERVICES RENDERED AS A RESULT OF THE20
DELAY.21
(b) T HE PENALTY DESCRIBED IN SUBSECTION (14)(a) OF THIS22
SECTION DOES NOT APPLY IF THE DELAY WAS THE RESULT OF FACTORS23
BEYOND THE NURSING FACILITY'S CONTROL.24
(15) THE STATE DEPARTMENT IS AUTHORIZED TO SEEK FEDERAL25
AUTHORIZATION TO ALLOW A NURSING FACILITY RESIDENT WHO REQUIRES26
SERVICES THROUGH A LONG -TERM CARE PROGRAM PURSUANT TO THIS27
HB26-1018-7-
ARTICLE 6 UPON DISCHARGE FROM A NURSING FACILITY TO BE1
PRESUMPTIVELY ELIGIBLE FOR LONG -TERM SERVICES AND SUPPORTS AS2
DESCRIBED IN THE STATE MEDICAL ASSISTANCE PROGRAM ESTABLISHED3
PURSUANT TO THIS ARTICLE 6 AND ARTICLES 4 AND 5 OF THIS TITLE 25.5.4
IF FEDERAL AUTHORIZATION IS NEEDED TO IMPLEMENT THE5
REQUIREMENTS OF THIS SECTION , THIS SECTION DOES NOT TAKE EFFECT6
UNTIL FEDERAL AUTHORIZATION IS APPROVED.7
(16) T HE STATE DEPARTMENT SHALL MAKE ANY NECESSARY8
CHANGES TO THE STATE PLAN WAIVERS FOR HOME - AND9
COMMUNITY-BASED SERVICE PROGRAMS AND ANY OTHER FEDERAL10
AUTHORIZATIONS THAT ARE AUTHORIZED PURSUANT TO THIS ARTICLE 6 TO11
COMPLY WITH THIS SECTION.12
(17) THE STATE DEPARTMENT SHALL SATISFY THE REQUIREMENTS13
OF THIS SECTION USING EXISTING RESOURCES OF THE STATE DEPARTMENT.14
SECTION 2. Act subject to petition - effective date. This act15
takes effect at 12:01 a.m. on the day following the expiration of the16
ninety-day period after final adjournment of the general assembly (August17
12, 2026, if adjournment sine die is on May 13, 2026); except that, if a18
referendum petition is filed pursuant to section 1 (3) of article V of the19
state constitution against this act or an item, section, or pa rt of this act20
within such period, then the act, item, section, or part will not take effect21
unless approved by the people at the general election to be held in22
November 2026 a nd, in such case, will take effect on the date of the23
official declaration of the vote thereon by the governor.24
HB26-1018-8-