HB 25-1213: Updates to Medicaid

Official summary

Abstract published by the legislature (via Open States). Text as published by the legislature; reproduced verbatim.

The act exempts an assisted living residence that has not undergone new construction or major renovations from complying with the facility guideline institute guidelines. The department of health care policy and financing (state department) must establish a process for reviewing and updating the general billing manual on an annual basis and ensure that the general billing manual includes all necessary CPT codes or links to the state department's list of CPT codes. The act allows the Colorado healthcare affordability and sustainability enterprise to receive public funds. Beginning January 1, 2026, for claims that must be reprocessed as a result of updating the provider rates, the act requires a managed care organization to issue payment to a contracted provider within one year after the provider rate is updated. The state department must notify the managed care organizations of changes to the provider rates within 60 days of changing the provider rates. The act requires the state department to include in each new contract with, or renewal of a contract with, a managed care entity (MCE) a provision requiring the MCE to submit to the state department, on an annual basis, the amount the MCE is paid and the MCE's medical loss ratio. The state department is required to publish this information, as well as historical medical loss ratio data for each MCE, and publish on an annual basis audit findings regarding an MCE's most recently completed medical loss ratio audit on the state department's website. The act prohibits the state department from imposing signature requirements on a physician or practitioner certifying a medicaid member's (member) plan of care that involves physical therapy, occupational therapy, or speech therapy. The act requires that for members receiving home- and community-based services, if a service the member receives is discontinued or no longer a covered service, the state department must confirm the timeline for the continuity of treatment with the federal centers for medicare and medicaid during the transition period of the benefit or service being discontinued and must communicate that timeline to the member impacted by the benefit or service being discontinued. (Note: This summary applies to this bill as enacted.)

Sponsors

Sponsors by party (alphabetical): Democratic 24 · Republican 2

“Support” is shown only as formal sponsorship recorded by the legislature. Roll-call votes are available on the official bill page.

Recent official actions

1. May 28, 2025Governor Signed
2. May 14, 2025Signed by the Speaker of the House
3. May 14, 2025Signed by the President of the Senate
4. May 14, 2025Sent to the Governor
5. May 1, 2025House Considered Senate Amendments - Result was to Concur - Repass
6. April 30, 2025Senate Third Reading Passed with Amendments - Floor
7. April 29, 2025Senate Second Reading Passed with Amendments - Committee, Floor
8. April 24, 2025Senate Committee on Health & Human Services Refer Amended to Senate Committee of the Whole
9. April 1, 2025Introduced In Senate - Assigned to Health & Human Services
10. March 26, 2025House Third Reading Passed - No Amendments
11. March 25, 2025House Committee on Appropriations Refer Amended to House Committee of the Whole
12. March 25, 2025House Second Reading Special Order - Passed with Amendments - Committee

Showing 12 most recent of 14 actions. Full history