April 29, 2017

Bills Regarding Notice of Medicaid Appeals, Special Respondents in Dependency and Neglect, and More Signed

On Thursday, April 6, 2o17, Governor Hickenlooper signed 15 bills into law. To date, the governor has signed 137 bills into law this legislative session. Some of the bills signed Thursday include a bill amending the definition of “special respondent” in the Colorado Children’s Code, a bill prohibiting a court from requiring a medical marijuana patient to abstain from marijuana use as a condition of bond, a bill codifying the presumption that a conveyance of land also includes the property interest in an adjacent vacated right-of-way, and a bill granting qualified immunity to persons performing land stewardship activities on public lands. These bills and the others signed Thursday are summarized here.

  • HB 17-1126: “Concerning the Review of Legal Sufficiency of Medicaid Appeals,” by Reps. Jessie Danielson & Dafna Michaelson Jenet and Sen. Larry Crowder. The bill requires an administrative law judge hearing Medicaid appeals to review the legal sufficiency of the notice of action from which the recipient is appealing at the commencement of the appeal hearing if the notice of action concerns the termination or reduction of an existing benefit, and to take appropriate action if the notice is insufficient.
  • HB 17-1173:“Concerning Medical Communications Regarding Disagreements in Health Care Decisions,” by Rep. Chris Hansen and Sen. Tim Neville. The bill requires a contract between a health insurance carrier and a health provider to include a provision that prohibits a carrier from taking an adverse action against the provider due to a provider’s disagreement with a carrier’s decision on the provision of health care services.
  • HB 17-1183: “Concerning the Repeal of the Condition Required to be Satisfied for a Provision of Law Governing the Disclosure of Communications with Mental Health Professionals to Take Effect,” by Rep. Mike Foote and Sen. Bob Gardner. The bill repeals the contingency provision contained in HB 16-1063 regarding the HIPAA privacy rule.
  • HB 17-1197: “Concerning the Exclusion of Marijuana from the Definition of ‘Farm Products’ with Regard to Regulation of Farm Products under the ‘Farm Products Act’,” by Rep. Joann Ginal and Sen. Don Coram. The bill excludes marijuana from the definition of ‘farm products’ requiring licensure under the Farm Products Act.
  • HB 17-1198“Concerning the Authority for a Special District to Increase the Number of Board Members from Five to Seven,” by Rep. Matt Gray and Sen. Bob Gardner. The bill allows a special district to increase the number of board members by adoption of a resolution by the board and the approval of the resolution by the board of county commissioners or the governing body of the municipality that approved the service plan of the special district.
  • SB 17-046: “Concerning the Modernization of Procedures Pertaining to Warrants and Checks not yet Presented to the State Treasurer for Payment,” by Sen. Jack Tate and Rep. Jeni Arndt. The bill modernizes current practices relating to warrants and checks not timely presented to the state treasurer for payment.
  • SB 17-065: “Concerning a Requirement that Health Care Providers Disclose the Charges they Impose for Common Health Care Services when Payment is made Directly Rather than by a Third Party,” by Sen. Kevin Lundberg and Rep. Susan Lontine. The bill creates the ‘Transparency in Health Care Prices Act’, which requires health care professionals and health care facilities to make available to the public the health care prices they assess directly for common health care services they provide.
  • SB 17-097“Concerning the Presumption that a Conveyance of an Interest in Land Also Conveys an Interest in Adjoining Property Consisting of a Vacated Right-of-Way,” by Sen. Beth Martinez Humenik and Rep. James Coleman. The bill broadens the application of the presumption of conveyance of an adjoining vacated right-of-way to include not only warranty deeds but also all forms of deeds, leases, and mortgages and other liens.
  • SB 17-100: “Concerning Qualified Immunity for Persons Performing Land Stewardship Activities on Public Lands,” by Sen. Jerry Sonnenberg and Reps. Jeni Arndt & Lois Landgraf. The bill strengthens existing legal protections under the federal ‘Volunteer Protection Act of 1997’ and Colorado’s ‘Volunteer Service Act’ for individual volunteers and nonprofit entities who build or maintain recreational trails and related facilities pursuant to grants received under Colorado’s ‘Recreational Trails System Act of 1971’.
  • SB 17-142: “Concerning the Requirement to Include Notification to a Patient Regarding the Patient’s Breast Tissue Classification with the Required Mammography Report,” by Sen. Angela Williams and Rep. Jessie Danielson. The bill requires that each mammography report provided to a patient include information that identifies the patient’s breast tissue classification based on the breast imaging reporting and data system established by the American College of Radiology.
  • SB 17-144: “Concerning the Recommended Continuation of the Education Data Advisory Committee by the Director of the Division of Professions and Occupations in the Department of Regulatory Agencies,” by Sens. Owen Hill & Rachel Zenzinger and Rep. Brittany Pettersen. The bill implements the recommendation of the Department of Regulatory Agencies to continue the education data advisory committee.
  • SB 17-146“Concerning Access to the Electronic Prescription Drug Monitoring Program,” by Sen. Cheri Jahn and Rep. Joann Ginal. The bill modifies provisions relating to licensed health professionals’ access to the electronic prescription drug monitoring program.
  • SB 17-177: “Concerning Amending the Definition of ‘Special Respondent’ in the Children’s Code to Allow a Person to be Voluntarily Joined in a Dependency or Neglect Proceeding,” by Sen. John Cooke and Rep. Paul Rosenthal. The bill amends the Children’s Code definition of “special respondent” to allow a party to be voluntarily joined in a dependency or neglect proceeding.
  • SB 17-178“Concerning Prohibiting a Court from Requiring a Medical-Marijuana Patient to Abstain from the Use of Marijuana as a Condition of Bond,” by Sen. Vicki Marble and Rep. Jovan Melton. The bill prohibits a court from imposing as a bond condition a ban on marijuana use if the person possesses a valid medical marijuana registry identification card.
  • SB 17-230“Concerning Payment of Expenses of the Legislative Department,” by Sens. Lucia Guzman & Chris Holbert and Reps. Patrick Neville & KC Becker. The bill makes appropriations for matters related to the legislative department for the 2017-18 state fiscal year.

For a list of the governor’s 2017 legislative actions, click here.

Electronic Court Notice Bill, Increase of Life Insurance Exemption Bill, Subpoena Clarifications Bill, and More Signed Monday.

On Monday, March 20, 2017, the governor signed 17 bills into law. To date, he has signed 80 bills this legislative session. Some of the bills signed Monday include a bill increasing the exemption amount for a cash surrender of life insurance, a bill authorizing the fiduciary of an endowment fund to distribute principal under a unitrust election, a bill allowing an attorney general or district attorney to issue a subpoena for people engaged in deceptive trade practices, a bill allowing court clerks to electronically notice parties, and a bill increasing the appropriation to the Department of Law for providing legal services to the Department of Education. The bills signed Monday are summarized here.

  • HB 17-1023“Concerning a Clarification of Procedures for Subpoenas for Deceptive Trade Practices,” by Reps. Tracy Kraft-Tharp & Cole Wist and Sens. Chris Holbert & Lois Court. The bill clarifies that the attorney general or a district attorney may issue a subpoena pursuant to C.R.C.P. 4 to a person whom he or she has reasonable cause to believe has engaged or is engaging in a deceptive trade practice in violation of Colorado statute.
  • HB 17-1039“Concerning Communication Issues Related to Restorative Justice,” by Rep. Pete Lee and Sen. Daniel Kagan. The bill allows the district attorney to consent to an assessment for suitability for participation in restorative justice practices, including victim-offender conferences, as part of a recommended sentence in a plea bargain.
  • HB 17-1041“Concerning Measures to Inform Students of Education Opportunities Leading to Jobs,” by Rep. Phil Covarrubias and Sen. Kevin Priola. The bill requires schools to inform students of military enlistment as a path to educational opportunities.
  • HB 17-1056“Concerning the Eligibility of a Veterans’ Service Organization to Accept Public Service Assignments Offered in Connection with Misdemeanor Sentencing,” by Rep. Michael Weissman and Sens. Bob Gardner & Andy Kefalas. The bill expands the criteria for organizations that may accept community or useful public service assignments to include veterans’ service organizations organized under 501(c)(4) or 501(c)(19) of the tax code, and specifies that the court or other entity making the assignment retains discretion to determine which organizations may be included in its program of community or useful public service.
  • HB 17-1061“Concerning Modification of the Class of Vehicles that is Subject to Regulation as Commercial Vehicles,” by Reps. Jon Becker & Jovan Melton and Sens. Nancy Todd & Ray Scott. The bill increases the minimum weight for classification as a commercial vehicle subject to the statutory and regulatory standards for commercial vehicles from 10,001 pounds to 16,001 pounds unless the vehicle is registered for use in interstate commerce.
  • HB 17-1093“Concerning an Increase in the Exemption for the Cash Surrender Value of Life Insurance,” by Rep. Kim Ransom and Sen. Daniel Kagan. The bill increases the exemption for cash surrender value of life insurance policies to $250,000.
  • HB 17-1096“Concerning Endowment Care Funds Administered for Cemetery Authorities,” by Rep. Larry Liston and Sen. Jim Smallwood. The bill authorizes the fiduciary of an endowment fund to distribute principal, such as capital gains, under a unitrust election.
  • HB 17-1135“Concerning the Portability of Employment Background Checks for a Child Care Worker who Works for the Same Common Ownership Entity,” by Rep. Jeff Bridges and Sen. Kevin Priola. The bill allows a child care worker who is employed in a licensed facility that is wholly owned, operated, and controlled by a common ownership group or school district to use a single completed fingerprint-based criminal history record check and a check of the records and reports of child abuse or neglect to satisfy the requirements of the necessary background checks if the employee also works for or transfers to another licensed facility.
  • HB 17-1142“Concerning Notices of Certain Court Proceedings,” by Rep. Dominique Jackson and Sen. Bob Gardner. The bill allows the clerk of the court to send notice by first-class mail or electronically using the e-filing system of the judicial department.
  • HB 17-1143“Concerning Audits of Correspondence Sent to Medicaid Clients,” by Rep. Lois Landgraf and Sen. Larry Crowder. The bill directs the Office of the State Auditor to conduct or cause to be conducted an audit of client correspondence, including letters and notices, sent to clients or potential clients in Medicaid programs.
  • SB 17-011“Concerning the Creation of a Technical Demonstration Forum to Study Solutions to Improve Transportation Access for People with Disabilities,” by Sen. Kent Lambert and Rep. Polly Lawrence. The bill creates a technical demonstration forum consisting of eight members to study and document how advanced technologies can improve transportation access for people with disabilities.
  • SB 17-041“Concerning Employment Contracts for Positions at Institutions of Higher Education that are Funded by Revenue Generated from Auxiliary Activities,” by Sen. Kevin Priola and Reps. Yeulin Willett & Edie Hooten. The bill exempts certain positions at institutions of higher education from limits for employment contract terms or amounts.
  • SB 17-060“Concerning Relocation of the Colorado Student Leaders Institute from the Office of the Lieutenant Governor to the Department of Higher Education, and, in Connection Therewith, Making and Reducing an Appropriation,” by Sen. Nancy Todd and Rep. James Wilson. The bill relocates the Colorado Student Leaders Institute to the Department of Higher Education with no changes to the program.
  • SB 17-077“Concerning the Eligibility of Certain Government Agencies to Apply for a Special Event Permit to Sell Alcohol Beverages,” by Sen. Cheri Jahn and Reps. Tracy Kraft-Tharp & Yeulin Willett. The bill authorizes certain agencies to obtain a special event permit to sell alcohol beverages for a limited period.
  • SB 17-109“Concerning the Use of Industrial Hemp in Products Designed for Consumption,” by Sen. Kerry Donovan and Rep. Jeni Arndt. The bill creates a group under the commissioner of agriculture to study the feasability of including hemp products in animal feed.
  • SB 17-196“Concerning the Improvement of the Department of Law’s Information Technology Security,” by Sen. Kevin Lundberg and Rep. Dave Young. The bill increases the appropriation to the Department of Law to improve the Department’s information technology security based on an external auditor’s recommendations.
  • SB 17-197“Concerning the Provision of Legal Services for the Department of Education in the 2016-17 State Fiscal Year,” by Sen. Kevin Lundberg and Rep. Dave Young. The bill increases the amount of reappropriated funds that are appropriated to the Department of Law for the purpose of providing additional legal services for the Department of Education.

For a list of the governor’s 2017 legislative actions, click here.

HB 17-1139: Exposing Medicaid Providers to Civil Damages for Improper Billing

On February 1, 2017, Reps. Lois Landgraf & Dafna Michaelson Jenet and Sens. John Kefalas & Beth Martinez Humenik introduced HB 17-1139, “Concerning Improving Medicaid Client Protections Through Effective Enforcement of Medicaid Provider Requirements.”

The bill subjects a provider of medicaid services to a civil monetary penalty if the provider improperly bills or seeks collection from a medicaid recipient or the estate of a medicaid recipient.

In addition, the bill allows the department of health care policy and financing (department) to require a corrective action plan from any provider who fails to comply with rules, manuals, or bulletins issued by the department, the medical services board, or the department’s fiscal agent or from a provider whose activities endanger the health, safety, or welfare of a medicaid recipient. Based on good cause, the department may suspend the enrollment of a medicaid provider for a period of time set forth in the bill. The provider has the right to appeal the suspension administratively.

The bill was introduced in the House and assigned to the Public Health Care & Human Services Committee.

SB 17-004: Allowing Nonenrolled Medicaid Providers to Charge for Services

On January 11, 2017, Sen. Jake Tate and Rep. Cole Wist introduced SB 17-004, “Concerning Access by Medicaid Recipients to Nonenrolled Medical Providers.”

Under current law, recipients of services under the Colorado medical assistance program (medicaid) are not responsible for the cost of services by a medical provider or the cost remaining after payment by medicaid or another private insurer, regardless of whether the medical provider is enrolled in the medicaid program, unless the medical services provided are nonreimbursable by medicaid. The bill amends the statute so that the prohibition on charging medicaid recipients for medical services applies only if the medical provider is enrolled in medicaid.

Prior to providing medical services to a medicaid recipient, a nonenrolled provider must enter into a written agreement with the recipient as specified in the bill. If the requirements are met, the medicaid recipient would be responsible for the cost of the medical services.

The bill was introduced in the Senate and assigned to the Health & Human Services Committee. It is scheduled to be heard in committee on January 26, 2017, at 1:30 p.m.

Residential Reconstruction Bill, Costs of District Health Agency Bill, and Bill Repealing Medicaid Claims Task Force Signed

On Tuesday, April 5, 2016, the governor signed three bills into law. To date, he has signed 73 bills into law this legislative session. The bills signed Tuesday include a bill to extend the time to complete residential reconstruction, a bill regarding the costs of district public health agencies, and a bill repealing the “Medicaid Clean Claims Task Force.” These three bills are summarized below.

  • SB 16-012 – Concerning the Authority of a Local Assessor to Grant Additional Time for a Landowner to Reconstruct Residential Improvements that were Destroyed by a Natural Cause, by Sen. Rollie Heath and Rep. Jonathan Singer. The bill allows residential property to maintain its property tax classification for an indefinite period of time if the county assessor finds the property owner is making a good faith effort to rebuild after a natural disaster.
  • SB 16-094 – Concerning the Shared Costs of a District Public Health Agency by the Counties in the District, by Sen. Larry Crowder and Rep. Ed Vigil. Currently, the largest county in a multi-county public health district must serve as treasurer and district costs must be apportioned based on population. The bill allows multi-county health districts with small populations more flexibility in choosing which county will act as treasurer and apportioning costs.
  • SB 16-127 – Concerning the Repeal of the “Medicaid Clean Claims Transparency and Uniformity Act,” by Sen. Jack Tate and Rep. Jeni James Arndt. The bill repeals the Medicaid Clean Claims Transparency and Uniformity Act, repeals all ongoing work of the Medicaid Clean Claims Task Force, and repeals the requirement that insurance companies bill using codes developed by the task force. Related statutory definitions are also repealed.

For a complete list of the governor’s 2016 legislative decisions, click here.

SB 16-027: Allowing Medicaid Clients to Receive Prescriptions Through the Mail

On January 13, 2016, Sens. Beth Martinez Humenik and Nancy Todd along with Reps. Dianne Primavera and Lois Landgraf introduced SB 16-027Concerning Allowing the Option for Medicaid Clients to Obtain Prescribed Drugs Through Mail, and, In Connection Therewith, Reducing an Appropriation. The bill has passed through the Senate Health & Human Services and Appropriations Committees with amendments in each committee and was passed on Second and Third Reading in the Senate Committee of the Whole. In the House, the bill passed out of the Health, Insurance, & Environment Committee with amendments and is now in the House Appropriations Committee.

The proposed bill specifically relates to persons receiving medical assistance (Recipients). The bill would allow recipients the option to receive prescribed medications, used to treat chronic medical conditions, through the mail. The bill also provides that the recipient may receive up to a certain amount of the medication and would still pay the same copayment amount as recipients receiving the medication by another method.

The proposed bill provides that the department of health care policy and financing shall encourage recipients to use any local retail pharmacy for mail delivery. Furthermore, the bill would require the state board of medical services to adopt rules, “to the extent allowed by federal law,” relating to the option to receive medications through the mail. Specifically, the bill proposes to make subsection (1)(a)(II) of C.R.S. § 25.5-5-505 mandatory, stating “the state board rules must include the definition of maintenance medications.”

The bill also proposes the addition of subsection (1)(c) of C.R.S. § 25.5-5-505. The subsection states “a pharmacy may provide maintenance medications through the mail to medical assistance recipients in accordance with all applicable state and federal laws if the pharmacy is enrolled as a provider with the state department and is registered with the state board of pharmacy, created and existing pursuant to C.R.S. § 12-42.5-103.”

Additionally, the Senate provided amendments to Section 2 of the proposed bill, Appropriations – Adjustments to 2016 Long Bill. The amendments provide, in relevant part, that to implement the Act, the appropriations made for the 2016-17 fiscal year to the Department of Health Care Policy and Financing for medical services premiums are adjusted in the following ways: (a) the general fund appropriation is decreased by $9,084; and (b) The cash funds appropriation from the hospital provider fee cash fund is decreased by $409. Furthermore, subsection (2) of Section 2 proposes that the fiscal year medical services premiums for the Department of Health Care Policy and Financing will be decreased by $20,424.

Mark Proust is a 2016 JD Candidate at the University of Denver Sturm College of Law.

Colorado Court of Appeals: No Error in Trial Court’s Calculation of Medicaid Lien

The Colorado Court of Appeals issued its opinion in State of Colorado Department of Health Care Policy & Financing v. S.P. on Thursday, June 18, 2015.

Accident—Medicaid—Settlement—Statutory Lien—Calculation.

S.P. was injured in a snowboarding accident at a ski area. As a result of her injuries, she is a paraplegic and will require ongoing medical care and assistance for the rest of her life. She applied for Medicaid assistance and was accepted. Over the course of several years, Medicaid paid $142,779 for her accident-related medical care. S.P. sued the ski area, alleging negligence, and eventually settled the case for $1 million. Medicaid was entitled to a statutory lien against the settlement for repayment of the medical assistance it had provided. The settlement agreement, however, did not specify the portion of the settlement amount attributable to medical expenses, as opposed to other categories of damages. The Medicaid administration agency sued S.P. to enforce its lien.

On appeal, both parties argued that the trial court incorrectly calculated the amount S.P. was required to repay to Medicaid. Colorado has not enacted statutory, administrative or other procedures for apportioning third-party settlements for Medicaid lien purposes. The trial court applied a proportional allocation formula to determine what amount out of S.P.’s settlement funds should be considered compensation for past medical expenses. The trial court also relied on an objective indication of S.P.’s total past medical expenses that was supported by the record.

The Court of Appeals held that the decision to rely on the amount paid rather than the amount billed by Medicaid was not clearly erroneous, and that the trial court’s method in this case was neither unreasonable nor arbitrary. The trial court also did not err in applying its formula to the gross settlement amount and properly took attorney fees into consideration in reducing the amount owed to Medicaid. The judgment was affirmed and the case was remanded to the trial court to release the funds held in its registry pursuant to the judgment.

Summary and full case available here, courtesy of The Colorado Lawyer.

SB 14-207: Providing that Contributions to Pooled Trusts by Individuals 65 Years of Age or Older Are Not Transfers Without Fair Consideration for Purposes of Medicaid Eligibility

On April 17, 2014, Sen. Nancy Todd introduced SB 14-207 – Concerning Contributions to Pooled Trusts by Individuals Who Are 65 Years of Age or Older. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

The transfer of assets by an individual who is 65 years of age or older to a pooled trust does not constitute a transfer without fair consideration. The department of health care policy and financing (department) shall not delay an individual’s eligibility for medical assistance or otherwise penalize an individual for entering into a joinder agreement, transfer agreement, or other agreement to transfer assets to a pooled trust so long as an actuarially sound spending plan is submitted with the agreement to the department or to a county department of social services that is responsible for acceptance of Medicaid applications.

The bill is assigned to the Finance Committee.

HB 14-1211: Requiring Complex Rehabilitation Technology to be Available to Medicaid Recipients

On January 30, 2014, Rep. Dave Young and Sen. Lois Tochtrop introduced HB 14-1211 – Concerning Ensuring Access to Quality Complex Rehabilitation Technology in the Medicaid Program. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

The bill requires the department of health care policy and financing (department) to recognize complex rehabilitation technology as a specific need of persons with complex diagnoses or medical conditions that result in significant physical or functional needs.

The department must designate appropriate billing codes as complex rehabilitation technology and establish supplier quality standards for complex rehabilitation technology suppliers. Additionally, the department must require evaluation of complex needs patients by qualified professionals for purposes of identifying appropriate complex rehabilitation technology. Further, the department must develop pricing policies for complex rehabilitation technology.

The bill defines terms relating to complex rehabilitation technology.

The bill is assigned to the Public Health Care & Human Services Appropriations Committees.

Probate Omnibus Bill, Employee Privacy, HOA Bills Signed by Governor Hickenlooper

Although the Colorado General Assembly adjourned sine die on May 8, 2013, bills continue to be signed into law by Governor Hickenlooper. To date, the governor has signed 231 bills. Some of the most recently signed bills are summarized below.

On Thursday, May 7, Governor Hickenlooper signed one bill — HB 13-1117 – Concerning Alignment of Child Development Programs, and, in Connection Therewith, Making and Reducing an Appropriation, by Rep. Millie Hamner and Sens. Mary Hodge and Andy Kerr. The bill consolidates several child development programs in the Department of Human Services and extends  the Early Childhood Leadership Council, which was set to sunset on July 1, 2013.

Governor Hickenlooper signed 18 bills into law on Friday, May 10, 2013. Six of them are summarized here.

On Saturday, May 11, 2013, the governor signed 19 bills into law. Five of them are summarized here.

Finally, on Monday, May 13, 2013, Governor Hickenlooper signed 11 bills into law. Four of them are summarized here.

For a complete list of Governor Hickenlooper’s 2013 legislative decisions, click here.

SB 13-205: Making the Colorado Medicaid False Claims Act Compliant with Federal Law

On Wednesday, March 13, 2013, Sen. Mary Hodge  introduced SB 13-205 – Concerning Revisions to the Colorado Medicaid False Claims Act to Comply with Federal Law. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

In order for Colorado to retain a greater percentage of monetary recoveries for fraudulent medicaid claims, the “Colorado Medicaid False Claims Act” (act) must be at least as effective as federal law in rewarding and facilitating qui tam actions for false and fraudulent claims. The bill amends the act to bring the act into compliance with federal law as follows:

  • Removes specific dollar amounts relating to the penalty and instead references federal law to determine the amount of the penalty and any adjustments to the penalty;
  • Corrects statutory language as to whom a claim is presented;
  • Clarifies that the act bars persons other than the state from intervening only in actions brought under this act and not in other actions;
  • Clarifies that the court does not have jurisdiction under this act against members of the general assembly, state judiciary, or an elected executive branch official if the claim is based upon information or evidence known to the state at the time the action is brought;
  • Clarifies that a person bringing the action (relator) cannot bring an action based upon allegations or transactions that are the subject of a civil suit or administrative civil money penalty proceeding in which the state is already a party;
  • Requires the court, with certain exceptions, to dismiss an action that is based upon allegations or transactions publicly disclosed in certain ways, unless the relator is the original source of the information;
  • Clarifies who can bring an action under the act for retaliation relating to employment and provides the time frame within which an action for retaliation must be brought; and
  • Amends the definitions of “obligation” and “original source.”
  • On March 20, the Health & Human Services Committee approved the bill and sent it to the full Senate for consideration on 2nd Reading.

    Since this summary, the bill was laid over daily on Second Reading.

    SB 13-137: Implementing a Medicaid Fraud Detection System

    On Tuesday, January 29, 2013, Sen. Ellen Roberts introduced SB 13-137 – Concerning System Improvements to Prevent Fraud in the Medicaid Program, and, in Connection Therewith, Employing Advanced Data Analytics. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

    The bill directs the chief information officer of the office of information technology (office) to design and implement a Medicaid fraud detection system (system) for the purpose of detecting and preventing Medicaid provider and client fraud, waste, and abuse.

    The system designed by the chief information officer shall include industry best practices relating to fraud detection and prevention. The chief information officer shall also incorporate emerging strategies and technologies into the system as they become available.

    Among other data and information, the system shall utilize Medicaid claims and billing data and information from providers, and state and federal agency data-matching systems.

    Utilizing appropriate data-sharing protocols, the bill requires state agencies to provide data and information to the office for purposes of implementing the system.

    The bill requires the department of health care policy and financing (state department) to collaborate with the office in the design, implementation, and operation of the system. Consistent with state and federal law concerning data sharing and medicaid records, the state department shall provide necessary data and information to the office concerning medicaid providers and clients.

    The state department shall participate in securing funding for the system, as such funding may be available, and shall consider various funding mechanisms for the system. The bill is assigned to the Health & Human Services Committee.