Health-Care Payment Programs

HOUSE BILL 26-1432
BY REPRESENTATIVE(S) Soper and Stewart K., Bacon, Boesenecker,
Bradley, Brown, Carter, Duran, English, Flanell, Froelich, Gonzalez R.,
Hamrick, Johnson, Lindsay, McCormick, Nguyen, Rydin, Story, Titone,
Winter T., Woodrow, McCluskie;
also SENATOR(S) Roberts and Pelton R., Catlin, Kipp, Coleman.
CONCERNING HEALTH-CARE PAYMENT PROGRAMS.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. In Colorado Revised Statutes, 25.5-4-402, amend
(3)(a) and (3)(b) as follows:
25.5-4-402. Providers -hospital reimbursement-hospital review
program -rules.
(3) (a) (I) In addition to the reimbursement rate process described
in subsection (1) of this section and subject to FEDERAL APPROVAL AND
adequate funding being made available pursuant to section 25.5-4-402.4,
the Colorado healthcare affordability and sustainability enterprise created
in section 25.5-4-402.4 (3) shall pay an additional amount based upon
performance IN THE HOSPITAL QUALITY INCENTIVE PROGRAM to those
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act.
hospitals that provide set vices that improve hcalth-catc outcomes fut thcit
patients, including DELIVER SAFER, MORE EFFECTIVE CARE THAT IMPROVES
PATIENT OUTCOMES AND REDUCES PREVENTABLE UTILIZATION TO REDUCE
HEALTH-CARE COSTS. THE HOSPITAL QUALITY INCENTIVE PROGRAM MUST
INCLUDE a performance metric related to workplace violence. The state
department shall dctctminc this amount based upon nationally tccognizcd
pctfotmancc measures established in 1ulcs adopted by the state boatd. The
state quality standat ds must be consistent with federal quality standat ds
published by an 01 ganization with expertise in health-cat c quality,
including, but not limited to, the federal ccntcts fut medicate and mcdicaid
set vices, the agency fut hcalthcat c r cs car ch and quality, or the national
quality forum.
(II) (A) PRIOR TO IMPLEMENTATION OF THE PROGRAM, THE
COLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY ENTERPRISE
BOARD SHALL APPROVE THE PERCENTAGE OF HOSPITALS' REIMBURSEMENT
IN THE HOSPITAL QUALITY INCENTIVE PROGRAM, PROGRAM STRUCTURE,
PERFORMANCE MEASURES, AND SCORING METHODOLOGY.
(B) WHEN APPROVING A PROGRAM PURSUANT TO THIS SUBSECTION
(3)(a), THE BOARD SHALL REQUIRE THAT NEW MEASURES REMAIN IN PLACE
FOR A DEFINED PERIOD OF TIME NOT TO EXCEED THREE YEARS PRIOR TO
MODIFICATIONORREPLACEMENTOFTHENEWMEASURES;EXCEPTTHATTHE
BOARD MAY APPROVE MODIFICATIONS OR REPLACEMENTS PRIOR TO THE END
OF THE DEFINED PERIOD OF TIME IF THE BOARD IS PRESENTED WITH EVIDENCE
THAT THE APPROVED MEASURES ARE NOT MEETING THE GOALS OF THE
PROGRAM OR REQUIRE TECHNICAL ADJUSTMENTS. NOTHING IN THIS
SUBSECTION (3)(a) PRECLUDES THE BOARD FROM RENEWING MEASURES
THAT MEET THE GOALS OF THE PROGRAM AFTER THE DEFINED PERIOD OF
TIME NOT TO EXCEED THREE YEARS HAS EXPIRED.
(C) ANY MODIFICATIONS TO THE HOSPITAL QUALITY INCENTIVE
PROGRAM MUST BE APPROVED BY THE BOARD PRIOR TO IMPLEMENTATION;
EXCEPT THAT CHANGES NECESSARY TO COMPLY WITH FEDERAL LAW MAY BE
IMPLEMENTED IMMEDIATELY.
(Ill) PERFORMANCE MEASURES AND METHODOLOGIES MUST BE
BASED ON FACTORS THAT ARE REASONABLY WITHIN HOSPITALS' CONTROL,
ALIGNED WITH NATIONALLY RECOGNIZED STANDARDS TO THE MAXIMUM
EXTENT PRACTICABLE, AND DESIGNED TO MINIMIZE ADMINISTRATIVE
PAGE 2-HOUSE BILL 26-1432
BURDEN, INCLUDING BY A VOIDING DUPLICATIVE REPORTING AND
LEVERAGING EXISTING DATA SOURCES WHEN POSSIBLE. THE HOSPITAL
QUALITY INCENTIVE PROGRAM SHOULD ALIGN WITH FEDERAL QUALITY
STANDARDS.
(b) (I) The amount of the payments made pursuant to subsection
(3)(a) ofthis section must be computed annually. For each state fiscal year,
the total amount of the payments must be no more than seven percent of the
total reimbursements made to hospitals in the previous state fiscal year.
(II) NOTWITHSTANDING SUBSECTION (3)(b )(1) OF THIS SECTION, THE
MAXIMUM PERCENTAGE OF PAYMENTS MUST NOT EXCEED SEVEN PERCENT
OF THE TOTAL REIMBURSEMENTS MADE TO HOSPITALS IN THE PREVIOUS
ST A TE FISCAL YEAR UNLESS AND UNTIL THE COLORADO HEAL TH CARE
AFFORDABILITY AND SUSTAINABILITY ENTERPRISE BOARD FORMALLY
APPROVES A HOSPITAL QUALITY INCENTIVE PROGRAM PURSUANT TO
SUBSECTION (3)(a) OF THIS SECTION, DEVELOPED WITH INPUT FROM
HOS PIT AL REPRESENTATIVES WITH CLINICAL EXPERTISE, AFTER WHICH THE
MAXIMUM PERCENTAGE OF PAYMENTS MUST NOT EXCEED NINE PERCENT OF
THE TOTAL REIMBURSEMENTS MADE TO HOSPITALS.
SECTION 2. In Colorado Revised Statutes, 25.5-4-402.4, amend
( 4 )( a )(IV)(E), ( 4 )( c )(I) introductory portion, ( 5)(b )(VIII), (7)( d)(V), and
(7)( e )(VI); and repeal (8) as follows:
25.5-4-402.4. Hospitals - healthcare affordability and
sustainability hospital provider fee - healthcare affordability and
sustainability nursing facility provider fee - healthcare affordability
and sustainability intermediate care facility fee -receipt of public funds
- Colorado healthcare affordability and sustainability enterprise -
federal waiver -funds created -reports -rules -legislative declaration
-definitions -repeal.
( 4) Healthcare affordability and sustainability hospital provider
fee.
(a) For the fiscal year commencing July 1, 201 7, and for each fiscal
year thereafter, the enterprise is authorized to charge and collect a
healthcare affordability and sustainability hospital provider fee, as described
in 42 CFR 433 .68 (b ), or as otherwise in compliance with 42 CFR 433, on
PAGE 3-HOUSE BILL 26-1432
outpatient and inpatient services provided by all licensed or certified
hospitals, and receive public funds as described in 42 CFR 433.51, for the
purpose of obtaining federal financial participation under the state medical
assistance program as described in this article 4 and articles 5 and 6 of this
title 25 .5, including disproportionate share hospital payments pursuant to 42
U.S.C. sec. 1396r-4. If the amount of hospital provider fee revenue
collected exceeds the federal net patient revenue-based limit on the amount
of such fee revenue that may be collected, requiring repayment to the
federal government of excess federal matching money received, hospitals
that received such excess federal matching money are responsible for
repaying the excess federal money and any associated federal penalties to
the federal government. The enterprise shall use the hospital provider fee
revenue to:
(IV) Provide or contract for or arrange the provision of additional
business services to hospitals by:
(E) Providing funding for, and in cooperation with the state
department and hospitals supporting the implementation of a health-care
delivery system reform incentive payments prngranr as described in
subsection (8) of this section THE HOSPITAL QUALITY INCENTIVE PROGRAM
CREATED IN SECTION 25.5-4-402 (3)(a).
( c) (I) In accordance with the redistributive method set forth in 42
CFR 433.68 (e)(l) and (e)(2), the enterprise, acting in concert with or
through an agreement with the state department if required by federal law,
may seek a waiver from the broad-based hospital provider fee requirement
or the uniform hospital provider fee requirement, or both. In addition, the
entetptise, acting in concert (\iith 01 thrnugh an agreement with the state
department if required by federal law, shall seek any federal waiver
necessary to fund and, in cooperation with the state department and
hospitals, support the implementation of a health-eat e deliv cry system
reform incentive payments prngram as described in subsection (8) of this
section. Subject to federal approval and to minimize the financial impact on
certain hospitals, the enterprise may exempt from payment of the hospital
provider fee certain types of hospitals, including but not limited to:
(5) Healthcare affordability and sustainability hospital provider
fee cash fund.
PAGE 4-HOUSE BILL 26-1432
(b) All money in the hospital provider fee cash fund is subject to
federal matching as authorized under federal law and, subject to annual
appropriation by the general assembly, shall be expended by the enterprise
for the following purposes:
(VIII) Subject to any necessary federnl waivers being obtained, to
provide funding for a health-care delivery system 1eform incentive
payments progrnm as desetibed in subsection (8) ofthis section SUBJECT TO
FEDERAL APPROVAL, FOR THE HOSPITAL QUALITY INCENTIVE PROGRAM
DESCRIBED IN SECTION 25.5-4-402 (3);
(7) Colorado healthcare affordability and sustainability
enterprise board.
(d) The enterprise board has, at a minimum, the following duties:
(V) To direct and oversee the enterprise in seeking, in concert with
or through an agreement with the state department if required by federal
law, any federal waiver necessary to fund and, in cooperation with the state
department and hospitals, support the implementation of a health-eate
delivery system 1efo1m incentive payments progrnm as desetibed in
subsection (8) of this section THE HOSPITAL QUALITY INCENTIVE PROGRAM
CREATED IN SECTION 25.5-4-402 (3)(a);
( e) On or before January 15, 2018, and on or before January 15 each
year thereafter, the enterprise board shall submit a written report to the
health and human services committee of the senate and the health and
human services committee of the house ofrepresentatives, or any successor
committees, the joint budget committee of the general assembly, the
governor, and the state board. The report shall include, but need not be
limited to:
(VI) A summary of:
(A) The efforts made by the enterprise acting in concert with m
through an agteement with the state department iftequited by federnl law,
to seek any fedet al w ai vet necessary to fund and, in eoopet ation with the
state department and hospitals, support the implementation of a health-eat e
delivery system 1efo1m incentive payments progrnm as desetibed in
subsection (8) of this section TO IMPLEMENT THE HOSPITAL QUALITY
PAGE 5-HOUSE BILL 26-1432
INCENTIVE PROGRAM REQUIRED PURSUANT TO SECTION 25.5-4-402 (3),
INCLUDINGINFORMATIONABOUTTHESTRUCTUREOFTHEHOSPITALQUALITY
INCENTIVE PROGRAM AND ANY RESULTS ACHIEVED AS A RESULT OF THE
HOSPITAL QUALITY INCENTIVE PROGRAM; and
(B) The progress actually made by the enterprise, in cooperation
with the state department and hospitals, towards the goal of implementing
such a program AND THE ENTERPRISE BOARD'S LEGISLATIVE
RECOMMENDATIONS FOR CHANGES TO THE HOSPITAL QUALITY INCENTIVE
PROGRAM.
(8) Ilealth-ca1 e deli\1e1-, system I efo11n incenti\1e payments
pr og1 a111 -funding and implementation. The ente1p1 ise, acting in conccrt
with m through an agreement with the state departinent if required by
federal law, shall seek any federal waiver necessary to fund and, in
cooperation with the state department and hospitals, support the
implementation, no earlier than October 1, 2019, of a health-care delivery
system refunn incentive payments program that will improve health-care
access and outcomes fur individuals set ved by the state department while
efficiently utilizing available financial resomces. Such a program must, at
a mtn1mmn:
(a) Include an initial planning phase to.
(I) Assess needs, and
(II) Dev clop achievable outco1ne-based met1 ics to be used to
measme progt ess towards progratn goals, including the goals of health-care
deli v cry system integration, imp1 O'V ed patient outcomes, and more efficient
pr O'V ision of care, and
(b) Addi ess the fullo wing focus at eas:
(I) Care coordination and care transition management,
(II) Integration ofph)isieal and behavioral health-care set vices,
(III) Chronic condition nranagement,
(IV) Targeted population health, and
PAGE 6-HOUSE BILL 26-1432
(V) Data-di iv en accountability and outcome measurement.
SECTION 3. Safety clause. The general assembly finds,
determines, and declares that this act is necessary for the immediate
preservation of the public peace, health, or safety or for appropriations for
the support and maintenance of the departments of the state and state
institutions.
Juli~"--.__
SPEAKER OF THE HOUSE
OF REPRESENTATIVES
Vanessa Reilly
CHIEF CLERK OF THE HOUSE
OF REPRESENTATIVES
James Rashad Coleman, Sr.
PRESIDENT OF
THE SENATE
Esther van Mourik
SECRETARY OF
THE SENATE
APPROVED o \N.--4h ».2.--v C\,+ 1 c: ~ a rrv't
and Time)
DO
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