June 26, 2019

2012 Medicaid Numbers Released by Colorado Department of Health Care Policy

On January 6, 2012, the Colorado Department of Health Care Policy and Financing released its 2012 Social Security Cost of Living Adjustments. According to the report, monthly Social Security and Supplemental Security Income benefits will increase by 3.6% in 2012. The 300% income limit, regional income trust maximum, Medicare premiums, home equity maximum, minimum monthly maintenance needs allowance maximum, and the community spouse resource allowance will also increase.

The following tables list the 2011 and 2012 income and resource limits for Adult and Long-Term Care Medicaid categories, regional income trust maximum, Medicare premiums, home equity maximum, minimum monthly maintenance needs allowance maximum, and the community spouse resource allowance.

Supplemental Security Income Limits

January 2011  January 2012
Individual in own home $674  $698
Individual in home of another $449.34  $465.34
Couple in own home $1,011  $1,048
Couple in home of another $674  $698
In-kind Support and Maintenance maximum (ISM) $244.66  $252.66
300% limit $2,022  $2,094

Nursing Facility

Income Trust Gross Income Limits and Average Private Pay Rate

January 2011 January 2012
Region I

Counties: Adams, Arapahoe, Boulder, Broomfield, Denver, and Jefferson

$6,914 $7,046
Region II

Counties: Cheyenne, Clear Creek, Douglas, Elbert, Gilpin, Grand, Jackson, Kit Carson, Larimer, Logan, Morgan, Park, Phillips, Sedgwick, Summit, Washington, Weld, and Yuma

$6,412 $6,690
Region III

Counties: Alamosa, Baca, Bent, Chaffee, Conejos, Costilla, Crowley, Custer, El Paso, Fremont, Huerfano, Kiowa, Lake, Las Animas, Lincoln, Mineral, Otero, Prowers, Pueblo, Rio Grande, Saguache, and Teller

$5,915 $6,190
Region IV

Counties: Archuleta, Delta, Dolores, Eatle, Garfield, Gunnison, Hinsdale, La Plata, Mesa, Moffat, Montezuma, Montrose, Ouray, Pitkin, Rio Blanco, Routt, San Juan, and San Miguel

$6,336 $6,566
Average Private Pay Rate $6,394 $6,623

Medicare

Medicare Part A – Hospital Insurance

Seniors and certain individuals under 65 with fewer than 30 work quarters of Medicare covered employment

$451
Medicare Part A – Hospital Insurance

Seniors over 65 with 30-39 quarters of Medicare covered employment

$289
Medicare Part B

Physician services, outpatient hospital services, certain home health services, durable medical equipment, and other items

$99.90
Medicare Skilled Nursing Facility Co-insurance

Days 21 thru 100 each benefit period

$144.50

Spousal Protection

January 1, 2011 January 1, 2012
Community Spouse Resource Allowance (CSRA) $109,560 $113,640
Minimum Monthly Maintenance Needs Allowance (Maximum) $2,739 $2,841

July 1, 2010 July 1, 2011
Minimum Monthly Maintenance Needs Allowance (MMMNA) $1,822 $1,839
Excess Shelter $547 $552

Home Equity Maximum

January 1, 2011 January 1, 2012
$506,000 $525,000

Contact Information: Medicaid.Eligibility@hcpf.state.co.us

Click here to review the full report.

SSI Medicaid Eligibility Rules for Children Under 21 Amended

The Colorado Department of Health Care Policy and Financing has amended the Medical Assistance Rules concerning Supplemental Security Income Medicaid eligibility effective dates for children under 21. The purpose of this rule change is to revise the eligibility requirements to incorporate changes in federal law governing the effective date of eligibility for individuals under 21 and to provide criteria for granting eligibility to infants who are found to be disabled shortly after birth.

The proposed language was approved for publication effective September 1, 2008. However, it was subsequently deleted through administrative error effective April 1, 2009. The proposed rule is being presented in order to reestablish the previously approved language.

A hearing on the proposed rules will be held on Friday, October 14, 2011 at The Capitol Center, 225 E. 16th Ave., 6th Floor, Denver, Colorado 80203, beginning at 9:00 am.

Full text of the proposed rules including line edits can be found here. Further information about the rules and hearing can be found here.

Department of Health Care Policy and Financing Amends Rule Regarding Medicaid Redeterminations

The Department of Health Care Policy and Financing has amended the rule regarding Medicaid redetermination forms and notices. The Medicaid redetermination form will now direct Medicaid clients to review their current information and direct them to take no action if there are no household changes to current information. The proposed rule also removes language regarding sending a second redetermination notice when the first is not received. If the first notice is not received, it is attestation from the client that information is correct and no changes have occurred in the household.

These amendments are designed to assists in streamlining the eligibility process and reduce the administrative burden to eligibility sites and clients.

A hearing on the amended rule will be held on Friday, September 9, 2011 at The Capitol Center, 225 E. 16th Ave., 6th Floor, Denver, Colorado 80203, beginning at 9:00 am.

Full text of the proposed changes with line edits to the rule can be found here. Further information about the rule and hearing can be found here.

Department of Health Care Policy and Financing Finalizes New Rule Regarding Colorado All-Payer Claims Database

The Department of Health Care Policy and Financing has finalized a new rule after public comment to establish the basis for submitting medical and pharmacy claims and eligibility and provider data to the Colorado All-Payer Claims Database. The purpose of the rule is to facilitate the reporting of health care and health quality data. Reporting to the database allows public and private health care purchasers, consumers, and data analysts to identify and compare health plans, insurers, care facilities, and care providers regarding the provision of safe, cost effective, and high quality health care services in the state.

The new rule includes term definitions, reporting requirements, and penalties for noncompliance.

A hearing on the finalized rule will be held on Wednesday, August 24, 2011 at the Capitol Center, 225 E. 16th Ave., 6th Floor, Denver, Colorado 80203, beginning at 8:30 am.

Full text of the finalized rule can be found here. Further information about rule and hearing can be found here.

Department of Health Care Policy and Financing Amends Rule Concerning the Colorado Indigent Care Program

The Colorado Department of Health Care Policy and Financing has amended the the medical assistance rule concerning the Colorado Indigent Care Program. These proposed amendments will align the definition of health care providers qualified to participate in the Colorado Indigent Care Program (CICP) with state law.

Legislation passed in the 2011 session, House Bills 11-1101 and 11-1323, and signed into law by Governor Hickenlooper changed the definition of “general provider” to include Federally Qualified Health Centers and Rural Health Centers. This rule change adds those two provider types to the list of qualified CICP providers.

A hearing on the amended rule will be held on Friday, August 12, 2011 at The Capitol Center, 225 E. 16th Ave., 6th Floor, Denver, Colorado 80203, beginning at 9:00 am.

Full text of the proposed changes with red line edits to the rule can be found here. Further information about the rule and hearing can be found here.

Department of Health Care Policy and Financing Amends Rule Regarding Telehealth Services for Medicaid Recipients

The Colorado Department of Health Care Policy and Financing has amended the medical assistance rule concerning telehealth home health services. The purpose of these proposed amendments is to implement SB 07-196, updated by HB 10-1005, to allow telehealth as a covered service for Colorado Medicaid Home Health recipients.

Home health telehealth is the monitoring of health care data through information processing technologies. It includes the collection of clinical data in a clients home, and the transmission of that data to a home health agency for a clinical assessment and review, and action as needed. These amendments are seen as necessary to initiate the service and comply with CRS 25.5-5-321.

Several items within the proposed rule have also been updated to decrease ambiguity and clarify the intent of the current rules.

A hearing on the amended rule will be held on Friday, August 12, 2011 at The Capitol Center, 225 E. 16th Ave., 6th Floor, Denver, Colorado 80203, beginning at 9:00 am.

Full text of the proposed changes with red line edits to the rule can be found here. Further information about the rule and hearing can be found here.

Department of Health Care Policy and Financing Amends Rule Regarding Pre-Admission Screenings to Medicaid Nursing Facilities

The Colorado Department of Health Care Policy and Financing has amended the Medical Assistance Rule Concerning Long Term Care Screening Guidelines. The proposed amendments will bring the rule into compliance with federal regulations regarding Medicaid.

  • The Pre-Admission Screening and Annual Resident Review (PASARR) is changed to Pre-Admission Screening and Resident Review (PASRR) to comply with the federal law that removes the requirement for an annual screening and institutes the requirement that a new screening be completed when there is a significant change in physical or mental condition.
  • The proposed rule includes the requirement to conduct the Level I Screening for all Medicaid clients in need of nursing facility care, rather than in specific circumstances.
  • References to “mental retardation” have been changed to “developmental disability.”
  • The rule has been rewritten in the approved Secretary of State format and organized for better readability.

A hearing on the amended rule will be held on Friday, August 12, 2011 at The Capitol Center, 225 E. 16th Ave., 6th Floor, Denver, Colorado 80203, beginning at 9:00 am.

Full text of the proposed changes with line edits to the rules can be found here. Further information about the rule and hearing can be found here.

Department of Health Care Policy and Financing Adopts New Rule Regarding Colorado All-Payer Claims Database

The Department of Health Care Policy and Financing has adopted a new rule to establish the basis for submitting medical and pharmacy claims and eligibility and provider data to the Colorado All-Payer Claims Database. The purpose of the rule is to facilitate the reporting of health care and health quality data. Reporting to the database allows public and private health care purchasers, consumers, and data analysts to identify and compare health plans, insurers, care facilities, and care providers regarding the provision of safe, cost effective, and high quality health care services in the state.

The new rule includes term definitions, reporting requirements, and penalties for noncompliance.

A hearing on the new rule will be held on Tuesday, July 12, 2011 at the Capitol Center, 225 E. 16th Ave., 6th Floor, Denver, Colorado 80203, beginning at 8:30 am.

Full text of the proposed changes and new rule can be found here. Further information about rule and hearing can be found here.