§ 25.5-5-304 — Hospice care

Colorado § 25.5-5-304

• Jurisdiction: Colorado
• Title 25.5: Health
• Art.: Colorado Medical Assistance Act -

Text

(1) The medical assistance program in this state
shall include hospice care. Except as otherwise provided in subsection (2) of this
section, hospice care shall be provided for a period of up to two hundred ten days in
accordance with rules adopted by the state board, which rules shall comply with 42
U.S.C. sec. 1396d, and shall include at least the following requirements:

(a) That a person shall obtain a certified medical prognosis indicating a life
expectancy of nine months or less, which certification shall comply with rules
adopted by the state board;

(b) That a person shall execute a waiver of other medical benefits available
under this article and articles 4 and 6 of this title, which election shall be executed
in accordance with rules adopted by the state board;

(c) That the service shall be reasonable and necessary for the palliation or
management of the terminal illness and related conditions.

(2) Hospice care may be provided to a person beyond two hundred ten days
if such person is recertified by a physician or hospice medical director as terminally
ill in accordance with subsection (1) of this section.

(3) (a) Subject to the receipt of any necessary federal authorization, for a
person who has executed the waiver described in paragraph (b) of subsection (1) of
this section and who is a resident in a class I facility, as defined in section 25.5-6-201 (13), the class I facility shall bill the state department and the state department
shall pay the class I facility for the room and board costs of the person.

(b) Subject to the receipt of any necessary federal authorization, the hospice
care provided pursuant to this section may include room and board in a hospice
inpatient facility licensed pursuant to section 25-3-101, C.R.S. The state department
is authorized to establish the reimbursement rate for the costs for room and board
at a licensed hospice inpatient facility for patients eligible for the routine level of
hospice care.

(c) (I) If required, the state department shall seek the appropriate federal
authorization, conditioned on the receipt of gifts, grants, or donations sufficient to
provide for the state's administrative costs of preparing and submitting the request,
to make the payment described in paragraph (a) of this subsection (3) and to
include room and board at a licensed hospice inpatient facility as described in
paragraph (b) of this subsection (3). On or before January 15, 2011, the state
department shall submit a brief report to the members of the health and human
services committees of the senate and house of representatives, or any successor
committees, on the status of any request for authorization pursuant to this
subparagraph (I). If federal authorization to implement the changes described in
paragraphs (a) and (b) of this subsection (3) is obtained, the state department shall
request, through the state budget process, that the changes be implemented
during the fiscal year following the year in which the approval is obtained.

(II) The state department is authorized to seek and accept gifts, grants, or
donations from private or public sources for the purpose of providing for the
administrative costs of preparing and submitting the request for federal approval
for the payments described in paragraphs (a) and (b) of this subsection (3). All such
private and public funds received through gifts, grants, or donations shall be
transmitted to the state treasurer, who shall credit the same to the hospice care
account in the department of health care policy and financing cash fund created
pursuant to section 25.5-1-109, which account is hereby created. Moneys in the
account shall be subject to appropriation and shall only be used for the purposes
described in this subparagraph (II).

(d) For the provision of pediatric hospice care, the state department shall
seek an exemption from the following federal medicaid requirements for the
eligibility of and election for hospice care:

(I) The mandatory do-not-resuscitate order;

(II) A physician's certification that a patient is expected to live less than six
months; and

(III) The nonallowance of curative care therapies concurrent with palliative
and hospice care.

(4) Repealed.

Legislative History

Source: L. 2006: Entire article added with relocations, p. 1868, � 7, effective July 1. L. 2010: IP(1) and (1)(a) amended and (4) added, (HB 10-1027), ch. 274, p. 1256, � 1, effective August 11; (3) added, (SB 10-061), ch. 247, p. 1104, � 1, effective August 11. L. 2025: (3)(d) added, (HB 25-1003), ch. 50, p. 222, � 2, effective July 1.