July 31, 2015
The Honorable Wayne W. Williams
Secretary of State
1560 Broadway, 2nd Floor
Denver, Colorado 80203
Dear Mr. Williams:
Attached is the Notice of Proposed Rules concerning Medical Assistance rules to be considered
for final adoption at the September 2015 meeting of the Medical Services Board of the
Department of Health Care Policy and Financing. The meeting will be held on Friday,
September 11, 2015, beginning at 9:00 A.M., in the seventh floor conference room at 303 East
17th Avenue, Denver, CO 80203.
This notice is submitted to you for publication, pursuant to § 24-4-103(3)(a) and (11)(a),
C.R.S.
Respectfully,
Judi Carey,
Medical Services Board Coordinator
Department of Health Care Policy and Financing
1570 Grant Street, Denver, CO 80203-1818 P 303.866.2993 F 303.866.4411
www.colorado.gov/hcpf
September 11, 2015 Rule Notice
Page 2
NOTICE OF PROPOSED RULES
The Medical Services Board of the Colorado Department of Health Care Policy and
Financing will hold a public meeting on Friday, September 11, 2015, beginning at 9:00
a.m., in the seventh floor conference room at 303 East 17th Avenue, Denver, CO
80203. Reasonable accommodations will be provided upon request prior to the
meeting, by contacting the Medical Services Board Coordinator at 303-866-4416.
A copy of the full text of these proposed rule changes is available for review from the
Medical Services Board Office, 1570 Grant Street, Denver, Colorado 80203, (303) 8664416, fax (303) 866-4411. Written comments may be submitted to the Medical
Services Board Office on or before close of business the Wednesday prior to the
meeting. Additionally, the full text of all proposed changes will be available
approximately one week prior to the meeting on the Department’s website.
MSB 15-07-08-A, Revision to the Medical Assistance Health Information
Office General Eligibility Rules at Sections 8.100.1 and 8.100.3.
Medical Assistance. The proposed rule change is to incorporate revisions identified during the
department’s regulatory efficiency review as mandated by Executive Order D 2012-002 (EO 2),
later codified by the Colorado General Assembly at Section 24-4-103.3 CRS (2014). The
governor has issued an Executive order which requires state agencies to review state rules
every five years to ensure rules are effective, efficient and essential. A regulatory review is
solely for the purpose of identifying those rules which are duplicative, overlapping, outdated
and inconsistent.
To achieve regulatory review goals, sections 8.100.1 and 8.100.3 have been revised and
updated to assure state rules are current and are in alignment with federal regulations. This
will have a positive impact on all Medical Assistance covered groups by eliminating any
confusion on duplicative, overlapping, outdated and inconsistent rules. The majority of
proposed changes provide clarifying language that codifies current practice and will have no
fiscal impact. The change to the treatment of home care allowances and the treatment of
business expenses effectively expand Medicaid in very specific circumstances, it is anticipated
that such cases will be relatively rare and not drive a significant fiscal impact. The Colorado
Benefits Management System (CBMS) does not need to be updated for section 8.100.1 and
8.100.3 since all rules are in alignment with our federal regulations. This rule is scheduled to
be effective on Nov. 1, 2015.
The authority for this rule is contained in 42 CFR 435.949, 42 CFR 435.603, 42 CFR 435.907,
43 CFR 431.305, 42 CFR 435.4, 26 USC 131 and, 25.5-1-301 through 25.5-1-303, CRS (2014)
MSB 15-07-08-B, Revision to the MAGI Medical Assistance Health Information
Office Eligibility Rules at Section 8.100.4
Medical Assistance. The proposed rule change is to incorporate revisions identified during the
department’s regulatory efficiency review as mandated by Executive Order D 2012-002 (EO 2),
1570 Grant Street, Denver, CO 80203-1818 P 303.866.2993 F 303.866.4411
www.colorado.gov/hcpf
September 11, 2015 Rule Notice
Page 3
later codified by the Colorado General Assembly at Section 24-4-103.3 CRS (2014). The
governor has issued an Executive order which requires state agencies to review state rules
every five years to ensure rules are effective, efficient and essential. A regulatory review is
solely for the purpose of identifying those rules which are duplicative, overlapping, outdated
and inconsistent.
To achieve regulatory review goals, section 8.100.4 has been revised and updated to assure
state rules are current and are in alignment with federal regulations. This will have a positive
impact on all MAGI-covered groups by eliminating any confusion on duplicative, overlapping,
outdated and inconsistent rules. Of the proposed rule changes, the change on Social Security
Disability Insurance (SSDI) for children’s eligibility is anticipated to drive additional costs. The
Department estimates that between 40 and 50 children would gain eligibility as a result of this
change in treatment of income, driving a fiscal impact of approximately $40,000 annually for
Medical Assistance programs. The Colorado Benefits Management System (CBMS) does not
need to be updated for section 8.100.4 since all rules are in alignment with our federal
regulations.
The authority for this rule making is contained in sections 42 CFR § 435.603, 42 CFR §
435.910,42 CFR § 435.406-407, 42 CFR § 435.940, 42 CFR § 435.495, 42 CFR § 435.910, 42
CFR § 435.112, 42 CFR § 435.116-119, 42 CFR § 435.952, 42 CFR § 435.222, 42 CFR §
435.308, 42 CFR § 435.1109, 42 CFR § 435.145, 42 CFR § 435.965, 42 CFR § 435.1101, 42
USC § 1396 a(a)(10)(A)(i),(ii); §§ 25.5-4-104 and 25.5-1-301 through 25.5-1-303, C.R.S.
(2014).
MSB 15-02-09-A, Revision to the Medical Assistance Home and Community Based
Services for Persons with Brain Injury Rule Concerning Independent Living Skills
Training (ILST), Section 8.516.10
Medical Assistance. Poorly defined definitions of service within the rule have created
ambiguity regarding appropriate ILST services. Clear definitions of services appropriately
provided within ILST have been added to the rule. Current licensing requirements creates
burdens and disincentives, resulting in a severe lack of providers. The Colorado Department of
Public Health and Environment was consulted and has agreed that Home Care License Class A
and B agencies may provider ILST services. This change from only allowing Class A agencies
to provide ILST services will increase the provider pool across the state. Detailed oversight and
staff training requirements added to the rule will ensure that ILST clients receive appropriate
services.
The authority for this rule is contained in 42 U.S.C. §1396n(c), and sections 25.5-6-704 and
25.5-1-301 through 25.5-1-303, C.R.S. (2014).
MSB 14-10-15-A, Revision to the Medical Assistance Health Programs Benefits
Management Rule Concerning Substance Use Services, Section 8.746
1570 Grant Street, Denver, CO 80203-1818 P 303.866.2993 F 303.866.4411
www.colorado.gov/hcpf
Medical Assistance. The revised rule defines the amount, scope, and duration of the
Outpatient Substance Use Disorder Treatment Services benefits by replacing the current rule
September 11, 2015 Rule Notice
Page 4
language with the Outpatient Fee-for-Service Substance Use Disorder Treatment Services
Benefit Coverage Standard, which will be incorporated directly into the rule as an appendix.
The authority for this rule is contained in Section 1905(a)(18) of the Social Security Act,
codified at 42 U.S.C. § 1396f(a)(2); 42 CFR Section 130 and sections 25.5-1-301 through 25.51-303, CRS (2014)
1570 Grant Street, Denver, CO 80203-1818 P 303.866.2993 F 303.866.4411
www.colorado.gov/hcpf