As used in this part 13, unless the context otherwise
requires:
(1)Advisory board means the board established in section 10-16-1307.
(2)Critical access hospital means a hospital that is federally certified or
undergoing federal certification as a critical access hospital pursuant to 42 CFR
485, subpart F. (3)(a) Equivalent rate means, for a hospital that is part of a pediatric
specialty hospital system where over ninety percent of the hospital system's
population served is under eighteen years of age and that has a level one pediatric
trauma center, the payment rate determined by the medicaid fee schedule for the
hospital from the most recent year for which a complete set of hospital financial
data is publicly available as of May 10, 2023, multiplied by a conversion factor eq
Free access — add to your briefcase to read the full text and ask questions with AI
As used in this part 13, unless the context otherwise
requires:
(1) Advisory board means the board established in section 10-16-1307.
(2) Critical access hospital means a hospital that is federally certified or
undergoing federal certification as a critical access hospital pursuant to 42 CFR
485, subpart F.
(3) (a) Equivalent rate means, for a hospital that is part of a pediatric
specialty hospital system where over ninety percent of the hospital system's
population served is under eighteen years of age and that has a level one pediatric
trauma center, the payment rate determined by the medicaid fee schedule for the
hospital from the most recent year for which a complete set of hospital financial
data is publicly available as of May 10, 2023, multiplied by a conversion factor equal
to the ratio of the statewide payment-to-cost ratio for medicare to the hospital's
specific payment-to-cost ratio for the most recent set of publicly available hospital
financial data as of May 10, 2023, which is 1.52.
(b) In any given year, the rate in subsection (3)(a) of this section must be
adjusted annually for cumulative inflation by a factor equal to the average
percentage increase in the medicare inpatient and outpatient prospective payment
systems over the previous three years.
(c) For any health-care service without an existing medicare reimbursement
rate and for services that have low volume statewide relative to other medicare
services, including pediatric or obstetric services, an equivalent rate means a rate
set by rule of the commissioner after consultation with a statewide association of
hospitals, physicians, other providers, and the department of health care policy and
financing. The equivalent rate must utilize the ratio of medicaid payment rates to
existing medicare payment rates whenever possible.
(4) Essential access hospital means a critical access hospital or general
hospital located in a rural area with twenty-five or fewer licensed beds.
(5) Essential community provider has the same meaning as set forth in
section 25.5-8-103 (6).
(6) General hospital means a hospital licensed as a general hospital by the
Colorado department of public health and environment.
(7) Health-care coverage cooperative has the same meaning as set forth in
section 10-16-1002 (2).
(8) Health-care provider means a health-care professional registered,
certified, or licensed pursuant to title 12 or a health facility licensed or certified
pursuant to section 25-1.5-103.
(9) Health system means a corporation or other organization that owns,
contains, or operates three or more hospitals.
(10) Medical inflation means the annual percentage change in the medical
care index component of the United States department of labor's bureau of labor
statistics consumer price index for medical care services and medical care
commodities for the Denver-Aurora-Lakewood area, or its applicable predecessor
or successor index, based on the average change in the medical care index over the
previous three years.
(11) (a) Medicare reimbursement rate means the facility-specific
reimbursement rate for a particular health-care service provided under the Health
Insurance for the Aged Act, Title XVIII of the federal Social Security Act, 42
U.S.C. sec. 1395 et seq., as amended.
(b) For a hospital that is reimbursed through the medicare prospective
payments systems rate for a critical access hospital, medicare reimbursement
rate means the rate based on allowable costs as reported in medicare cost reports
and the historical cost-to-charge ratios for the specific hospital.
(12) Public benefit corporation means a public benefit corporation formed
pursuant to part 5 of article 101 of title 7 that may be organized and operated by the
exchange pursuant to section 10-22-106 (3).
(13) Small group market means the market for small group sickness and
accident insurance.
(14) Standardized plan means the standardized health benefit plan
designed by rule of the commissioner pursuant to section 10-16-1304.