Long-term Care Services for Nursing Home Residents

Second Regular Session Seventy-fifth General Assembly STATE OF COLORADO INTRODUCED HOUSE BILL 26-1018 LLS NO. 26-0051.02 Chelsea Princell x4335 HOUSE SPONSORSHIP Jackson and Joseph, SENATE SPONSORSHIP Amabile, House Committees Senate Committees Health & Human Services A BILL FOR AN ACT CONCERNING THE ESTABLISHMENT OF LONG-TERM SERVICES AND SUPPORTS FOR AN INDIVIDUAL TRANSITIONING OUT OF A NURSING FACILITY.

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 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: SECTION 1. In Colorado Revised Statutes, add 25.5-6-315 as follows:

25.5-6-315. Long-term services and supports for nursing facility residents - discharge planning - presumptive eligibility - reporting - definition.

(1) AS USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE REQUIRES, "PRESUMPTIVE ELIGIBILITY" HAS THE MEANING SET FORTH IN

SECTION 25.5-5-204.

(2) (a) IF THE STATE DEPARTMENT RECEIVES FEDERAL AUTHORIZATION PURSUANT TO SECTION NECESSARY, SUBSECTION (15) OF THIS SECTION, AN INDIVIDUAL BEING DISCHARGED FROM A NURSING FACILITY IS PRESUMPTIVELY ELIGIBLE FOR THE MEDICAL ASSISTANCE PROGRAM PURSUANT TO THIS ARTICLE 6 AND ARTICLES 4 AND 5 OF THIS TITLE 25.5 TO RECEIVE LONG-TERM SERVICES AND SUPPORTS, INCLUDING HOME- AND COMMUNITY-BASED SERVICES, PURSUANT TO THIS ARTICLE 6 IF THE INDIVIDUAL:

25.5-5-204 (2.7) AND, AS

(I) IS FUNCTIONALLY ELIGIBLE FOR LONG-TERM SERVICES AND SUPPORTS PURSUANT TO THIS ARTICLE 6; AND

(II) ATTESTS TO INFORMATION THAT MEETS THE INCOME, ASSETS, AND IMMIGRATION ELIGIBILITY REQUIREMENTS FOR THE MEDICAL ASSISTANCE PROGRAM.

(b) THE ATTESTATION REQUIRED BY SUBSECTION (2)(a)(II) OF THIS SECTION MUST BE MADE TO THE STATE DEPARTMENT IN THE MANNER PRESCRIBED BY THE STATE DEPARTMENT AT THE TIME OF THE FUNCTIONAL ELIGIBILITY ASSESSMENT REQUIRED IN SUBSECTION (4) OF THIS SECTION.

(3) A NURSING FACILITY SHALL NOTIFY THE STATE DEPARTMENT WITHIN THREE BUSINESS DAYS OF AN INDIVIDUAL WHO IS ELIGIBLE TO TRANSITION OUT OF A NURSING FACILITY AFTER DETERMINING THE INDIVIDUAL'S ELIGIBILITY TO TRANSITION OUT OF THE NURSING FACILITY.

(4) (a) THE STATE DEPARTMENT MUST ASSESS AN INDIVIDUAL BEING DISCHARGED FROM A NURSING FACILITY TO DETERMINE WHETHER THE INDIVIDUAL IS FUNCTIONALLY ELIGIBLE FOR LONG-TERM SERVICES AND SUPPORTS PURSUANT TO THIS ARTICLE 6 WITHIN ONE BUSINESS DAY AFTER RECEIVING NOTIFICATION THAT THE INDIVIDUAL IS ELIGIBLE TO TRANSITION OUT OF A NURSING FACILITY. A FUNCTIONAL ELIGIBILITY DETERMINATION MUST BE MADE BEFORE HOUSING IS SECURED FOR THE INDIVIDUAL.

(b) IF THE STATE DEPARTMENT DETERMINES THAT AN INDIVIDUAL IS FUNCTIONALLY ELIGIBLE FOR LONG-TERM SERVICES AND SUPPORTS PURSUANT TO THIS ARTICLE 6 AND SUBSECTION (4)(a) OF THIS SECTION, AND THE INDIVIDUAL COMPLETED THE ATTESTATION REQUIRED IN SUBSECTION (2)(a)(II) OF THIS SECTION, THE STATE DEPARTMENT SHALL DETERMINE THAT THE INDIVIDUAL IS PRESUMPTIVELY ELIGIBLE TO RECEIVE LONG-TERM SERVICES AND SUPPORTS PURSUANT TO THIS SECTION.

DEPARTMENT THAT THE INDIVIDUAL IS PRESUMPTIVELY ELIGIBLE.

(c) THE STATE DEPARTMENT SHALL NOTIFY THE COUNTY UPON RECEIPT OF THE PRESUMPTIVE ELIGIBILITY DETERMINATION MADE PURSUANT TO SUBSECTION (4)(b) OF THIS SECTION AND WITHIN THREE BUSINESS DAYS AFTER RECEIVING THE NOTIFICATION, THE COUNTY DEPARTMENT MUST ENROLL THE INDIVIDUAL IN LONG-TERM SERVICES AND SUPPORTS THAT MEET THE INDIVIDUAL'S NEEDS. THE COUNTY DEPARTMENT SHALL NOT ENGAGE IN A FINANCIAL ELIGIBILITY DETERMINATION FOR THE INDIVIDUAL.

(5) THE INDIVIDUAL OR THE INDIVIDUAL'S LEGAL REPRESENTATIVE MUST SUBMIT AN APPLICATION FOR LONG-TERM SERVICES AND SUPPORTS TO THE STATE DEPARTMENT WITHIN TEN CALENDAR DAYS AFTER THE PRESUMPTIVE ELIGIBILITY DETERMINATION.

(6) IF AN INDIVIDUAL BEING DISCHARGED FROM A NURSING FACILITY IS DETERMINED TO BE PRESUMPTIVELY ELIGIBLE FOR SERVICES THROUGH A LONG-TERM CARE PROGRAM PURSUANT TO THIS ARTICLE 6, ANY PRIOR AUTHORIZATION REQUIRED FOR A SERVICE PROVIDER TO BILL FOR HOME HEALTH SERVICES RENDERED TO THE INDIVIDUAL MUST BE APPROVED BY THE STATE DEPARTMENT, AND THE NECESSARY SERVICES MUST BE IN PLACE PRIOR TO THE INDIVIDUAL'S DATE OF DISCHARGE FROM THE NURSING FACILITY.

(7) AFTER PRESUMPTIVE ELIGIBILITY IS DETERMINED FOR AN INDIVIDUAL, THE NURSING FACILITY MUST WORK WITH ALL APPROPRIATE ENTITIES TO ENSURE THE LONG-TERM SERVICES AND SUPPORTS THAT THE INDIVIDUAL REQUIRES ARE IN PLACE PRIOR TO THE INDIVIDUAL'S DATE OF DISCHARGE FROM THE NURSING FACILITY.

(8) THE PRESUMPTIVE ELIGIBILITY PERIOD BEGINS ON THE DATE THE INDIVIDUAL IS DETERMINED FUNCTIONALLY ELIGIBLE FOR LONG-TERM SERVICES AND SUPPORTS PURSUANT TO THIS ARTICLE 6 AND SUBSECTION (4)(a) OF THIS SECTION AND ENDS ON THE LATER OF:

(a) THE LAST DAY OF THE MONTH FOLLOWING THE MONTH OF THE PRESUMPTIVE ELIGIBILITY DETERMINATION IF A LONG-TERM SERVICE AND SUPPORT APPLICATION IS NOT COMPLETED AND SUBMITTED PURSUANT TO SUBSECTION (5) OF THIS SECTION WITHIN TEN CALENDAR DAYS AFTER THE PRESUMPTIVE ELIGIBILITY DETERMINATION; OR (b) THE LAST DAY OF THE MONTH THAT FINAL ELIGIBILITY DETERMINATION IS MADE IF A LONG-TERM SERVICE AND SUPPORT APPLICATION IS SUBMITTED PURSUANT TO SUBSECTION (5) OF THIS SECTION WITHIN TEN CALENDAR DAYS AFTER THE PRESUMPTIVE ELIGIBILITY DETERMINATION.

(9) IF IT IS DETERMINED THAT AN INDIVIDUAL IS NOT ELIGIBLE FOR MEDICAL BENEFITS AFTER THE INDIVIDUAL WAS DETERMINED TO BE ELIGIBLE FOR SERVICES THROUGH A LONG-TERM CARE PROGRAM PURSUANT TO THIS ARTICLE 6 BASED ON PRESUMPTIVE ELIGIBILITY, THE STATE DEPARTMENT SHALL NOT PURSUE RECOVERY FROM A COUNTY DEPARTMENT FOR THE COST OF MEDICAL SERVICES PROVIDED TO THE INDIVIDUAL. THE COUNTY DEPARTMENT IS NOT RESPONSIBLE FOR ANY FEDERAL ERROR RATE SANCTIONS RESULTING FROM THE DETERMINATION.

(10) REDETERMINATION OF ELIGIBILITY FOR MEDICAL ASSISTANCE MUST TAKE PLACE ANNUALLY ON THE DATE THE MEMBER WAS INITIALLY ENROLLED IN THE STATE MEDICAL ASSISTANCE PROGRAM.

(11) ON OR BEFORE JANUARY 1, 2028, AND EACH JANUARY 1 THEREAFTER, THE STATE DEPARTMENT SHALL SUBMIT A REPORT TO THE STATE AUDITOR AND POST THE REPORT ON THE STATE DEPARTMENT'S WEBSITE DETAILING THE FOLLOWING FOR THE PREVIOUS CALENDAR YEAR:

(a) THE NUMBER OF INDIVIDUALS DISCHARGED FROM A NURSING FACILITY WHO WERE DETERMINED TO BE PRESUMPTIVELY ELIGIBLE FOR LONG-TERM SERVICES AND SUPPORTS AS DESCRIBED IN THE STATE MEDICAL ASSISTANCE PROGRAM ESTABLISHED PURSUANT TO THIS ARTICLE 6 AND ARTICLES 4 AND 5 OF THIS TITLE 25.5;

(b) HOW LONG IT TOOK FOR EACH PRESUMPTIVE ELIGIBILITY DETERMINATION TO BE MADE;

(c) HOW LONG IT TOOK TO DETERMINE FUNCTIONAL ELIGIBILITY AND FINANCIAL ELIGIBILITY FOR EACH INDIVIDUAL;

(d) FOR EACH INDIVIDUAL, THE NUMBER OF DAYS BETWEEN WHEN THE STATE DEPARTMENT NOTIFIED THE COUNTY DEPARTMENT THAT THE INDIVIDUAL WAS FUNCTIONALLY ELIGIBLE FOR LONG-TERM SERVICES AND SUPPORTS AND WHEN THE COUNTY DEPARTMENT ENROLLED THE INDIVIDUAL IN LONG-TERM SERVICES AND SUPPORTS;

(e) THE NUMBER OF INDIVIDUALS WHO WERE DETERMINED TO BE PRESUMPTIVELY ELIGIBLE FOR LONG-TERM SERVICES AND SUPPORTS AND DISCHARGED FROM A NURSING FACILITY WITHOUT LONG-TERM SERVICES AND SUPPORTS IN PLACE AND THE REASON THAT THE NECESSARY SERVICES AND SUPPORTS WERE NOT IN PLACE AT THE TIME OF THE INDIVIDUAL'S DISCHARGE FROM THE NURSING FACILITY; AND

(f) A LIST OF LOCAL SUPPORT AGENCIES, INCLUDING ANY OF THE STATE-CONTRACTED INDEPENDENT LIVING CENTERS, AREA AGENCY ON AGING CENTERS, OR OTHER COMMUNITY SUPPORT AGENCIES, THAT PROVIDE SERVICES TO THE ELDERLY, BLIND, OR DISABLED COMMUNITY.

(12) UPON RECEIPT OF THE REPORT SUBMITTED PURSUANT TO SUBSECTION (11) OF THIS SECTION, THE STATE AUDITOR MAY CONDUCT AN AUDIT OF THE STATE DEPARTMENT FOR ANY DELAY DETAILED IN THE REPORT THAT RESULTED IN AN INDIVIDUAL BEING DISCHARGED FROM A NURSING FACILITY WITHOUT LONG-TERM SERVICES AND SUPPORTS IN PLACE.

(13) IF A COUNTY DEPARTMENT FAILS THREE TIMES WITHIN A CALENDAR YEAR TO ENROLL AN INDIVIDUAL IN LONG-TERM SERVICES AND SUPPORTS WITHIN THREE BUSINESS DAYS AFTER RECEIVING NOTIFICATION FROM THE STATE DEPARTMENT AS REQUIRED BY SUBSECTION (3)(c) OF THIS RESPONSIBILITY TO ANOTHER AGENCY OR VENDOR.

SECTION,

(14) (a) THE STATE DEPARTMENT MAY TRANSFER THE IF A NURSING FACILITY FAILS TO DISCHARGE AN INDIVIDUAL ON THE DATE OF DISCHARGE 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 ON THE INDIVIDUAL'S DATE OF DISCHARGE, THE STATE DEPARTMENT MAY ISSUE A BILLING PENALTY RESULTING IN THE NURSING FACILITY'S INABILITY TO BILL THE MEDICAL ASSISTANCE PROGRAM FOR UP TO A MAXIMUM OF SEVEN CALENDAR DAYS FOR THE SERVICES RENDERED AS A RESULT OF THE DELAY.

(b) THE PENALTY DESCRIBED IN SUBSECTION (14)(a) OF THIS SECTION DOES NOT APPLY IF THE DELAY WAS THE RESULT OF FACTORS BEYOND THE NURSING FACILITY'S CONTROL.

(15) THE STATE DEPARTMENT IS AUTHORIZED TO SEEK FEDERAL AUTHORIZATION TO ALLOW A NURSING FACILITY RESIDENT WHO REQUIRES SERVICES THROUGH A LONG-TERM CARE PROGRAM PURSUANT TO THIS ARTICLE PRESUMPTIVELY ELIGIBLE FOR LONG-TERM SERVICES AND SUPPORTS AS DESCRIBED IN THE STATE MEDICAL ASSISTANCE PROGRAM ESTABLISHED PURSUANT TO THIS ARTICLE 6 AND ARTICLES 4 AND 5 OF THIS TITLE 25.5.

IF REQUIREMENTS OF THIS SECTION, THIS SECTION DOES NOT TAKE EFFECT UNTIL FEDERAL AUTHORIZATION IS APPROVED.

6 UPON DISCHARGE FROM A NURSING FACILITY TO BE FEDERAL AUTHORIZATION IS NEEDED TO IMPLEMENT THE

(16) THE STATE DEPARTMENT SHALL MAKE ANY NECESSARY CHANGES COMMUNITY-BASED SERVICE PROGRAMS AND ANY OTHER FEDERAL AUTHORIZATIONS THAT ARE AUTHORIZED PURSUANT TO THIS ARTICLE 6 TO COMPLY WITH THIS SECTION.

TO THE STATE PLAN WAIVERS FOR HOME - AND

(17) THE STATE DEPARTMENT SHALL SATISFY THE REQUIREMENTS OF THIS SECTION USING EXISTING RESOURCES OF THE STATE DEPARTMENT.

SECTION 2. Act subject to petition - effective date. This act takes effect at 12:01 a.m. on the day following the expiration of the ninety-day period after final adjournment of the general assembly (August 12, 2026, if adjournment sine die is on May 13, 2026); except that, if a referendum petition is filed pursuant to section 1 (3) of article V of the state constitution against this act or an item, section, or part of this act within such period, then the act, item, section, or part will not take effect unless approved by the people at the general election to be held in November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.