STATE OF COLORADO



COLORADO DEPARTMENT OF HEALTH CARE POLICY & FINANCING

1570 Grant Street, Denver, CO 80203-1818 [pic] (303) 866-2993[pic] (303) 866-4411 Fax[pic] (303) 866-3883 TTY

John Hickenlooper, Governor [pic] Susan E. Birch, MBA, BSN, RN, Executive Director

September 28, 2012

The Honorable Scott Gessler

Secretary of State

1560 Broadway, 2nd Floor

Denver, Colorado 80203

Dear Mr. Gessler:

Attached is the Notice of Proposed Rules concerning Medical Assistance rules to be considered for final adoption at the November 2012 meeting of the Medical Services Board of the Department of Health Care Policy and Financing. The meeting will be held on Friday, November 9, 2012, beginning at 9:00 A.M., in the sixth floor conference room at the Capitol Center, 225 East 16th 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.

Sincerely,

Judi Carey,

Coordinator

Medical Services Board

attachments

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, November 9, 2012, beginning at 9:00 a.m., in the sixth floor conference room at the Capitol Center, 225 East 16th 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, tel. (303) 866-4416, 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 internet at .

MSB 12-04-27-A. Revision to the Medical Assistance Rule Concerning Medicaid Home Health Covered Services and Prior Authorization, Section 8.522 and 8.527

10 CCR 2505-10 §8.522 – Covered Services and § 8.527 – Prior Authorization. The purpose of the rule revision to §8.522 is to incorporate the Home Health Benefit Collaborative Coverage Statement into the existing Home Health rule. The purpose of the rule revision to §8.527 is to change named prior authorization review agencies with the term “Department or its designated review entity.” This term is inclusive of all of the agencies who are authorized to review Home Health prior authorization request requests and will allow the rule to remain accurate regardless of contract changes. The revision also streamlines the Prior Authorization section and removes redundant or outdated information.

The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2011).

MSB 12-08-31-A. Revision to the Medical Assistance Rule Concerning Medicare Part D Coverage, Section 8.800.4

Certain drugs are becoming Medicare Part D drugs in accordance with 42 U.S.C. § 1395w-102(e)(2)(A) and as a result, will no longer be covered drugs under the Medicaid program. Therefore, the rule regarding prescription drug coverage, 10 C.C.R. 2505-10, Sections 8.800.4, is being amended.

The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2011).

MSB 12-06-21-A. Revision to the Medical Assistance Rule Concerning Pharmacy Reimbursement Calculations and Associated Definitions, Section 8.800.13 and 8.800.1

The Department is proposing the implementation of a new Average Acquisition Cost (AAC) reimbursement methodology for Fee-For-Service (FFS) pharmaceutical claims. 10 C.C.R. 2505-10, Section 8.800.1 and 10 C.C.R. 2505-10, Section 8.800.13 are being amended to account for this change in FFS pharmaceutical reimbursement methodologies.

The authority for this rule is contained in 25.5-1-301 through 25.5-1-303, C.R.S. (2011).

MSB 11-03-16-A. Revision to the Medical Assistance Rule Concerning Physician Services, Section 8.200

This physician services rule change includes clarification of the current practice regarding direct supervision of non-physician practitioners. The recommended changes make supervisory requirements of mid-level non-physician practitioners consistent with state law and practice. The existing rule requires physicians to order all care delivered by nurse practitioners, certified registered nurse anesthetists, and certified nurse midwives. State practice is for these providers to order care within their scope of practice.

This rule change also organizes the rule into discrete sections and moves all reimbursement requirements to one section and simplifies reimbursement rules.

MSB 12-07-03-A. Revision to the Medical Assistance Rule Concerning Income Limits for Children and Pregnant Women, Section 8.100.4.F, 8.100.4.G

FM SB 11-008 and 11-250 call for increasing the income limits for two of our Family and Children’s categories. Statute 25.5-5-205 was updated pursuant to SB 11-008 and SB 11-250 to increase the income limit for children ages six through eighteen from 100% FPL to 133% FPL and to increase the income limit for pregnant women from 133% FPL to 185% FPL.

MSB 12-04-20-A. Revision to the Medical Assistance Rule Concerning Claims Reimbursement and Status, Section 8.041

Claims Reimbursement for Status to include National Correct Coding Initiative (NCCI). Note: Basis of this rule is a set of edits, a definition of the type of claims subject to the edits, and rules regarding the application of the edits and provider appeals of denied payments. This rule is necessary to promote and control improper coding leading to improper Medicaid payments that will show a cost savings to the program.

The authority for this rule is contained in 25.5-4-300.7 C.R.S. (2011).

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