SB 188

SENATE BILL 26-188
BY SENATOR(S) Amabile and Kirkmeyer, Bridges, Exum, Simpson,
Coleman;
also REPRESENTATIVE(S) Brown and Taggart, Sirota, Boesenecker,
Clifford, Duran, Gilchrist, Lindsay, McCormick, Ricks, Rydin, Smith,
McCluskie.
CONCERNING THE TRANSITION OF RESIDENTIAL TREATMENT PROGRAMS TO
        THE STATEWIDE MANAGED CARE SYSTEM FOR MEDICAID MEMBERS
        WHO ARE IN THE CUSTODY OF A COUNTY DEPARTMENT OF HUMAN OR
        SOCIAL SERVICES.
Be it enacted by the General Assembly of the State of Colorado:
      SECTION 1. In Colorado Revised Statutes, add 25.5-1-137 as
follows:
        25.5-1-137. Transition of services provided in qualified
residential treatment facilities and psychiatric residential treatment
facilities to managed care system - steering committee - policies and
recommendations - report.
        (1) (a) NO LATER THAN JULY 1, 2026, THE STATE DEPARTMENT
________
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act.
SHALL CONVENE A STEERING COMMITTEE TO SUPPORT THE TRANSITION OF
SERVICES PROVIDED IN QUALIFIED RESIDENTIAL TREATMENT PROGRAMS AND
PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES TO THE MANAGED CARE
SYSTEM FOR MEMBERS IN THE CARE AND CUSTODY OF A COUNTY
DEPARTMENT OF HUMAN OR SOCIAL SERVICES. THE STEERING COMMITTEE
MAY CONSULT WITH OTHER STATE DEPARTMENTS AND AGENCIES, INCLUDING
THE DEPARTMENT OF EARLY CHILDHOOD, AND RELEVANT STAKEHOLDERS AS
NECESSARY TO FULFILL ITS DUTIES. THE STEERING COMMITTEE MUST
INCLUDE LEADERSHIP REPRESENTATION FROM:
      (I) THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING;
      (II) THE DEPARTMENT OF HUMAN SERVICES;
      (III)   THEBEHAVIORAL HEALTH        ADMINISTRATION   IN   THE
DEPARTMENT OF HUMAN SERVICES;
      (IV) COUNTY DEPARTMENTS OF HUMAN OR SOCIAL SERVICES;
      (V) QUALIFIED RESIDENTIAL TREATMENT PROGRAM PROVIDERS AND
PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY PROVIDERS, INCLUDING A
STATEWIDE ASSOCIATION REPRESENTING PROVIDERS; AND
      (VI) MANAGED CARE ENTITIES.
      (b) BEGINNING JULY 1, 2026, THE STEERING COMMITTEE SHALL MEET
AT LEAST ONCE PER MONTH UNTIL JULY 1, 2027.
      (c) THE STEERING COMMITTEE SHALL IDENTIFY, EVALUATE, AND
DEVELOP RECOMMENDATIONS ON POLICY AND OPERATIONAL ISSUES
RELATED TO THE TRANSITION DESCRIBED IN SUBSECTION (1)(a) OF THIS
SECTION AND ENSURE THAT UPDATES, POTENTIAL DECISION POINTS, AND
DECISIONS MADE BY THE STATE DEPARTMENT ARE COMMUNICATED TO AND
VETTED WITH THE LEADERSHIP OF EACH MEMBER'S RESPECTIVE
ORGANIZATION OR CONSTITUENCY.
     (2) NO LATER THAN APRIL 1, 2027, THE STATE DEPARTMENT, IN
COLLABORATION WITH THE STEERING COMMITTEE, SHALL DEVELOP POLICIES
AND RECOMMENDATIONS IN LINE WITH FEDERAL FINANCIAL PARTICIPATION
AND MANAGED CARE REGULATIONS AND REQUIREMENTS TO SUPPORT THE
PAGE 2-SENATE BILL 26-188
TRANSITION OF QUALIFIED RESIDENTIAL TREATMENT PROGRAMS AND
PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES TO THE MANAGED CARE
SYSTEM FOR MEMBERS IN THE CARE AND CUSTODY OF A COUNTY
DEPARTMENT OF HUMAN OR SOCIAL SERVICES. THE POLICIES AND
RECOMMENDATIONS MUST INCLUDE, BUT ARE NOT LIMITED TO:
      (a)    CLEARLY DEFINED ROLES, RESPONSIBILITIES, AND
DECISION-MAKING AUTHORITY ACROSS MANAGED CARE ENTITIES, COUNTIES,
PROVIDERS, AND STATE AGENCIES, INCLUDING ACCOUNTABILITY FOR
MEDICAL NECESSITY DETERMINATIONS, PLACEMENT DECISIONS, DISCHARGE
PLANNING, CARE COORDINATION, AND PAYMENT;
      (b) STATEWIDE STANDARDS FOR UTILIZATION MANAGEMENT,
INCLUDING AUTHORIZATION, CONTINUED STAY REVIEW, AND DISCHARGE
PLANNING, WITH CLARITY ON THE APPLICATION OF MEDICAL NECESSITY
DETERMINATIONS AND CONSIDERATION OF THE UNIQUE CLINICAL AND
PLACEMENT-RELATED NEEDS OF CHILDREN AND YOUTH INVOLVED IN THE
CHILD WELFARE SYSTEM;
      (c) REQUIREMENTS FOR TIMELY ENGAGEMENT, AUTHORIZATION, AND
CARE COORDINATION ACROSS ENTITIES, INCLUDING DEFINED TIME FRAMES
AND EXPECTATIONS FOR REAL-TIME COORDINATION FOR YOUTH IN CRISIS OR
AT RISK OF PLACEMENT DISRUPTION;
     (d) TRAINING AND TECHNICAL ASSISTANCE NEEDS FOR MANAGED
CARE ENTITIES, COUNTIES, AND QUALIFIED RESIDENTIAL TREATMENT
PROGRAM AND PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY PROVIDERS
RELATED TO THE CONSISTENT APPLICATION OF MEDICAL NECESSITY
CRITERIA, INCLUDING DOCUMENTATION EXPECTATIONS AND AUTHORIZATION
PROCESSES AND TIMELINES FOR EACH;
       (e) CARE COORDINATION EXPECTATIONS ACROSS MANAGED CARE
ENTITIES, COUNTIES, AND QUALIFIED RESIDENTIAL TREATMENT PROGRAM
AND PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY PROVIDERS TO
IMPROVE COMMUNICATION, REDUCE DUPLICATION, AND SUPPORT
CONTINUITY OF CARE, INCLUDING HOW FAMILIES ARE INTEGRATED INTO THE
TREATMENT PROCESS AND PROCESSES TO ADDRESS CARE COORDINATION
AND ACCESS TO SERVICES FOR YOUTH IN DETENTION, WITH CLARITY ON
ELIGIBILITY, ASSIGNMENT TO MANAGED CARE ENTITIES, AND ROLES AND
RESPONSIBILITIES FOR COVERAGE, AUTHORIZATION, AND COORDINATION OF
PAGE 3-SENATE BILL 26-188
BEHAVIORAL HEALTH SERVICES DURING AND FOLLOWING PERIODS OF
DETAINMENT;
      (f) DISCHARGE PLANNING REQUIREMENTS AND AFTER-CARE SUPPORT
FOR AT LEAST SIX MONTHS AFTER DISCHARGE, INCLUDING EXPECTATIONS
THAT DISCHARGE PLANNING BEGINS AT ADMISSION AND THAT ALL RELEVANT
PARTIES HAVE A SHARED UNDERSTANDING OF THE DISCHARGE PLAN AND OF
AVAILABLE STEP-DOWN AND COMMUNITY-BASED SERVICE OPTIONS;
      (g) RECOMMENDATIONS TO ADDRESS SYSTEM BARRIERS RELATED TO
DISCHARGE PLANNING, PLACEMENT AVAILABILITY, AND CONTINUITY OF
CARE, INCLUDING ALIGNMENT BETWEEN CLINICAL READINESS FOR
DISCHARGE AND AVAILABLE PLACEMENT OR COMMUNITY-BASED SERVICE
OPTIONS;
      (h) PROCESSES FOR TRANSITIONING MEMBERS RECEIVING QUALIFIED
RESIDENTIAL TREATMENT SERVICES AND PSYCHIATRIC RESIDENTIAL
TREATMENT SERVICES PRIOR TO JULY 1, 2027, FROM FEE-FOR-SERVICE TO
MANAGED CARE ON JULY 1, 2027, INCLUDING TIMING AND RESPONSIBILITY;
      (i) STATEWIDE REQUIREMENTS FOR MANAGED CARE ENTITIES,
INCLUDING MINIMUM EXPECTATIONS FOR PROCESSES , TIMELINES,
APPLICATION OF POLICIES RELATED TO AUTHORIZATION, UTILIZATION
MANAGEMENT, CARE COORDINATION, AND SERVICE DELIVERY; DECISION
MAKING; AND APPLICATION OF THE EARLY AND PERIODIC SCREENING,
DIAGNOSTIC, AND TREATMENT BENEFIT;
      (j) DATA, REPORTING, AND TRANSPARENCY NEEDS NECESSARY TO
SUPPORT IMPLEMENTATION, OVERSIGHT, AND ONGOING EVALUATION OF THE
TRANSITION; AND
      (k) CONSIDERATION OF FISCAL IMPACTS AND ALIGNMENT ACROSS
ENTITIES, INCLUDING POTENTIAL COST SHIFTS, RATE ADEQUACY, AND
FUNDING RESPONSIBILITIES ASSOCIATED WITH THE TRANSITION.
      (3) NO LATER THAN JULY 1, 2027, THE STATE DEPARTMENT SHALL
IMPLEMENT OR INITIATE THE TRANSITION OF SERVICES PROVIDED IN
QUALIFIED RESIDENTIAL TREATMENT PROGRAMS AND PSYCHIATRIC
RESIDENTIAL TREATMENT FACILITIES TO THE MANAGED CARE SYSTEM FOR
MEMBERS IN THE CARE AND CUSTODY OF A COUNTY DEPARTMENT OF HUMAN
PAGE 4-SENATE BILL 26-188
OR SOCIAL SERVICES ACCORDING TO THE POLICIES AND RECOMMENDATIONS
DEVELOPED PURSUANT TO SUBSECTION (2) OF THIS SECTION.
     (4) NO LATER THAN OCTOBER 1, 2026, DECEMBER 31, 2026, AND
MARCH 1, 2027, THE STATE DEPARTMENT SHALL SUBMIT A QUARTERLY
REPORT TO THE JOINT BUDGET COMMITTEE THAT INCLUDES:
       (a) THE DATES THE STEERING COMMITTEE MET DURING THE
PREVIOUS QUARTER;
       (b) A LIST OF ATTENDEES AT EACH MEETING;
       (c) A SUMMARY OF THE TOPICS DISCUSSED; AND
       (d) A SUMMARY OF DECISIONS MADE TO DATE.
      (5) NO LATER THAN JULY 1, 2028, THE STATE DEPARTMENT SHALL
SUBMIT A REPORT TO THE JOINT BUDGET COMMITTEE OUTLINING:
       (a) THE OUTCOMES OF THE IMPLEMENTED POLICIES;
     (b) ANY IDENTIFIED IMPACTS TO PLACEMENT STABILITY, CARE
COORDINATION, AND SYSTEM ALIGNMENT; AND
       (c)RECOMMENDATIONS FOR ANY STATUTORY OR BUDGETARY
CHANGES NECESSARY TO SUPPORT ONGOING IMPLEMENTATION.
        SECTION 2. In Colorado Revised Statutes, 25.5-5-202, amend
(5)(c) as follows:
       25.5-5-202. Basic services for the categorically needy - optional
services - repeal.
       (5) (c) This subsection (5) is repealed, effective July 1, 2027 JULY
1, 2026.
        SECTION 3. In Colorado Revised Statutes, 25.5-5-402, amend
(2)(c)(II) as follows:
       25.5-5-402. Statewide managed care system - rules - definitions
PAGE 5-SENATE BILL 26-188
- repeal.
        (2) The statewide managed care system implemented pursuant to
this article 5 does not include:
      (c) (II) This subsection (2)(c) is repealed, effective July 1, 2026
JULY 1, 2027.
       SECTION 4. Safety clause. The general assembly finds,
determines, and declares that this act is necessary for the immediate
preservation of the public peace, health, or safety or for appropriations for
PAGE 6-SENATE BILL 26-188
the support and maintenance of the departments of the state and state
institutions.
____________________________        ____________________________
James Rashad Coleman, Sr.  Julie McCluskie
PRESIDENT OF  SPEAKER OF THE HOUSE
THE SENATE  OF REPRESENTATIVES
____________________________        ____________________________
Esther van Mourik  Vanessa Reilly
SECRETARY OF  CHIEF CLERK OF THE HOUSE
THE SENATE  OF REPRESENTATIVES
       APPROVED________________________________________
                          (Date and Time)
                 _________________________________________
                Jared S. Polis
                GOVERNOR OF THE STATE OF COLORADO
PAGE 7-SENATE BILL 26-188