Colorado’s Citizen Legislature – Mar 2017

~ By Doris Beaver ~

The 2017 General Assembly is focusing considerable attention on improving the system for Medicare and Medicaid client experiences regarding communications such as client letters and notices concerning eligibility matters, and proper billing to recipients or the estate of recipients.

Senate Bill 17-121: The General Assembly declared that

1) Understandable, timely, informative and clear communications from the state department are critical to the life and health of medicaid recipients, and in some cases, are a matter of life and death for our most vulnerable population;

2) Unclear, confusing and late correspondence from the state department causes an increased workload for the state, counties administering the Medicaid program and nonprofit advocacy groups assisting clients; and

3) Government should be a good steward of taxpayers’ money, ensuring that it is spent in the most cost-effective manner.

If passed and enacted, SB 121 will require the Department of Health Care Policy and Financing (HCPF) to engage in an ongoing process to create, test and improve Medicaid client communications, and ensure that communications with clients are accurate, readable, understandable and consistent. All communications regarding a denial, reduction, suspension or termination of benefits, must include:

  • an understandable explanation of denial, reduction, suspension or termination;
  • detailed information on the client’s household composition and income sources; and
  • a specific description of any information or documents needed from the client.

A somewhat unusual provision in SB 121 for this type of legislation is that “when modifying Medicaid communication, HCPF is required to test the changes and solicit feedback from clients and stakeholders, and to appropriately prioritize communications that only affect a small number of clients or vulnerable populations.” The HCPF will also be required to present to the General Assembly in its annual presentation information on its ongoing process to improve client communications.

Lead Sponsors of Senate Bill 17-121: Senator Larry Crowder (R-Alamosa, Baca, Bent, Conejos, Crowley, Custer, Huerfano, Kiowa, Las Animas, Mineral, Otero, Prowers, Pueblo, Rio Grande, Saguache) 866-4875; and Representative Jessie Danielson (D-Jefferson) 866-5522.

House Bill 17-1094: Teleheath care services are of real benefit for those who do not drive or are in rural areas far from medical clinics and hospitals. Several modifications to the existing requirements are made by HB 1094:

  • a health plan cannot restrict or deny coverage for a covered benefit provided using telehealth services based on the communication technology or application used to deliver services;
  • the availability of telehealth does not modify insurance carriers’ existing obligation under state law to maintain a sufficient network of local health care providers;
  • covered individuals may receive telehealth services from a private residence, but health insurers are not required to cover the transmission cost incurred from using telehealth services from a home or other originating site fees;
  • the applicable copayment, coinsurance or deductible for telehealth services should be applied by the carrier and may not exceed the applicable cost sharing amounts for in-person services;
  • an HIPAA-compliant interactive audio-visual communication and HIPAA-compliant applications via cellular telephones may be used for telehealth, but the voice-only telephone and text messaging may not be used.

Lead Sponsors of House Bill 17-1094: Representative Perry Buck (R-Larimr, Weld) 866-2907; and Senator Larry Crowder (R-Alamosa, Baca, Bent, Conejos, Crowley, Custer, Huerfano, Kiowa, Las Animas, Mineral, Otero, Prowers, Pueblo, Rio Grande, Saguache) 866-4875.

House Bill 17-1139: Titled “Improving Medicaid Client Protections Through Effective Enforcement of Medicaid Provider Requirements,” HB 1139”subjects a provider of medical services to a civil monetary penalty if the provider improperly bills or seeks collection from a Medicaid recipient or their estate.” (writer’s emphasis). Two significant provisions are also provided in HB 1139:

1) The Department of Health Care and Policy and Financing is to require a corrective action plan from any provider where substantial non-compliance or quality issues are identified; and

2) allows the HCPF to temporarily suspend a provider’s enrollment in Colorado’s Medicaid program for a defined period of time.

Lead Sponsors of House Bill 17-1139: Representative Lois Landgraf (R-El Paso) 866-2946; and Senator Beth Martinez Humenik (R-Adams) 866-4863.

Doris Beaver

Doris Beaver

Doris Beaver is a free lance journalist who writes from her home high in the Colorado Rocky Mountains on senior issues, politics, ethics and environmental issues. Visit her website www.dorisbeaver.com, or e-mail her at doris@dorisbeaver.com.


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