Title of Proposed Rule:
Rule-making#:
Change to County Reimbursement of Medical Exam (Med 9)
07-4-30-1
Program: Aging and Adult
Services/Aid to the Needy
Disabled Program
Rule Author: Susan Kern
Phone: 303-866-2810
STATEMENT OF BASIS AND PURPOSE
Summary of the basis and purpose for the rule or rule change. (State what the rule says or does, explain why the
rule or rule change is necessary and what the program hopes to accomplish through this rule.)
This rule is necessary to allow Aid to the Needy Disabled (AND) applicants or recipients to remain on the AND
program by submitting the doctor's completed medical statement for disability at redetermination. In April, Delta
County reported that no medical personnel in their county is willing to complete the Med 9 for the amount specified
in rules. Additionally, Julie Reiskin, Executive Director of Colorado Cross Disability Coalition, reported that clients
were unable to find medical personnel in Denver to complete the medical exams.
The State Department has been paying counties a reimbursement for medical personnel who fill out a disability
statement (Med 9) for Aid to the Needy Disabled applicants or recipients through County Administration funds for
the amount which is specified in rules as $22.50 maximum for general examinations and up to $75 maximum per
special examination. The current rate of reimbursement for the Medical Exam prohibits participants from finding
doctors who are willing to complete the form. This new rule would allow counties to negotiate rates with providers.
An emergency rule-making (which waives the initial APA noticing requirements) is necessary:
to comply with state/federal law and/or
X
to preserve of the public health, safety and welfare
Explain: It is necessary for this rule to be promulgated on an emergency basis to preserve the public's health and
welfare. Clients unable to produce a Med 9, as certification of their medical condition, will be discontinued from the
AND program pursuant to statutory requirements if there are no medical personnel to complete the Med 9 form.
Authority for Rule:
State Board Authority: 26-1-107, C.R.S. (2006) - State Board to promulgate rules; 26-1-109, C.R.S. (2006) - State
Board rules to coordinate with federal programs; 26-1-111, C.R.S. (2006)- State Board to promulgate rules for
public assistance and welfare activities.
Program Authority: (give federal and/or state cite and a summary of the language authorizing the rule-making)
26-2-106(6)(a), C.R.S. (2006) - no application for aid to the needy disabled (public assistance) shall be approved
until the applicant's medical condition has been certified by a physician licensed to practice medicine in this state;
26-2-111(4)(e), C.R.S. (2006) - no applicant disabled as a result of a primary diagnosis of alcoholism or a controlled
substance addiction shall be approved for aid to the needy disabled, except under certain provisions.
Initial Review
07/13/2007
Final Adoption
08/03/2007
Proposed Effective Date
07/13/2007
EMERGENCY Adoption
07/13/2007
DOCUMENT 3
Rule-making Form SBA-3a (6/02)
Title of Proposed Rule:
Rule-making#:
Change to County Reimbursement of Medical Exam (Med 9)
07-4-30-1
Program: Aging and Adult
Services/Aid to the Needy
Disabled Program
Rule Author: Susan Kern
Phone: 303-866-2810
STATEMENT OF BASIS AND PURPOSE (continued)
Does the rule incorporate material by reference?
Yes
X
No
Yes
X
No
Does this rule repeat language found in statute?
If yes, please explain.
State Board Administration will send this rule-making package to CCI, OSPB and the JBC. The program has sent this
rule-packet to which stakeholders?
Policy Advisory Committee-Aging and Adult Services (PAC-AAS) Subcommittee; Colorado Legal Services;
Colorado Coalition for the Homeless; Catholic Charities; Colorado Department of Health Care, Policy and
Financing
Attachments:
Regulatory Analysis
Overview of Proposed Rule
Stakeholder Comment Summary
Rule-making Form SBA-3a (6/02)
Title of Proposed Rule:
Rule-making#:
Change to County Reimbursement of Medical Exam (Med 9)
07-4-30-1
Program: Aging and Adult
Services/Aid to the Needy
Disabled Program
Rule Author: Susan Kern
Phone: 303-866-2810
REGULATORY ANALYSIS
(complete each question; answers may take more than the space provided)
1. List of groups impacted by this rule
Which groups of persons will benefit, bear the burdens or be adversely impacted by this rule?
Aid to the Needy Disabled applicants/recipients, medical professionals, and counties
2. Describe the qualitative and quantitative impact
How will this rule-making impact those groups listed above? How many people will be impacted? What are the
short-term and long-term consequences of this rule?
This rule will allow disabled individuals to remain on the program by providing the funds for medical personnel to
complete the Med 9 form. The short-term consequences of this rule would allow the same number of AND clients to
remain on the program. The long-term consequences of this rule would allow the same number of applicants to apply
and remain on the program since the requirement of the AND program is the completed Med 9.
3. Fiscal Impact
For each of the categories listed below explain the distribution of dollars; please identify the costs, revenues,
matches or any changes in the distribution of funds even if such change has a total zero effect for any entity that
falls within the category. If this rule-making requires one of the categories listed below to devote resources without
receiving additional funding, please explain why the rule-making is required and what consultation has occurred
with those who will need to devote resources.
State Fiscal Impact (Identify all state agencies with a fiscal impact, including any CBMS change request
costs required to implement this rule change)
None
County Fiscal Impact
It is estimated that the negotiated reimbursement rates could increase 530% ($22.50x530%=$120).
Historically, Med 9 reimbursements total approximately $140,000 per year ($112,000 State reimbursed cost
and $38,000 county funds). The source of the State reimbursement is the County Administration line. If
the total reimbursement rate was increased to $120 per exam, the estimated cost of the reimbursements
could increase to $742,000 ($593,600 State reimbursed and $148,400 county cost). The actual fiscal
impact will depend on the actual rates counties negotiate with providers (estimated at $400,000 to
$742,000). It should be noted that counties would have an incentive to negotiate low rates, as 20% of the
total cost is financed by local county funds. Within the County Administration line, counties have the
discretion to expend for multiple programs. The Aid to the Needy Disabled-State Only (AND-SO) program
is one of those within this line.
Federal Fiscal Impact
None
Other Fiscal Impact (such as providers, local governments, etc.)
Unknown
Rule-making Form SBA-3b (6/02)
Title of Proposed Rule:
Rule-making#:
Change to County Reimbursement of Medical Exam (Med 9)
07-4-30-1
Program: Aging and Adult
Services/Aid to the Needy
Disabled Program
Rule Author: Susan Kern
Phone: 303-866-2810
REGULATORY ANALYSIS (continued)
4. Data Description
List and explain any data, such as studies, federal announcements, or questionnaires, you relied upon when
developing this rule?
5. Alternatives to this Rule-making
Describe any alternatives that were seriously considered. Are there any less costly or less intrusive ways to
accomplish the purpose(s) of this rule? Explain why the program chose this rule-making rather than taking no
action or using one of the listed alternatives.
a. Do nothing. This was not chosen because of the adverse consequences to AND Clients.
b. This rule change is a way to make a difference for the affected clients and meet the needs of the counties.
c. Individual counties will negotiate rates with providers in their communities.
Rule-making Form SBA-3b (6/02)
Title of Proposed Rule:
Rule-making#:
Change to County Reimbursement of Medical Exam (Med 9)
07-4-30-1
Program: Aging and Adult
Services/Aid to the Needy
Disabled Program
Rule Author: Susan Kern
Phone: 303-866-2810
OVERVIEW OF PROPOSED RULE
Compare and/or contrast the content of the current regulation and the proposed change.
Section Numbers
Current Regulation
Proposed Change
Stakeholder Comment
3.492.21
Payment for medical
exams: allows
reimbursement of a rate up
to $22.50 maximum for
general examinations and
up to $75 maximum per
special examination
Deletes the dollar amounts
and adds use of the 80%
State share 20% county
share
__
Yes
X
No
3.490.22
Negotiated fees:
references maximum fee
amounts in Section
3.490.21
Deletes the wording which
references fee amounts in
Section 3.490.21.
__
Yes
X
No
_
Y
e
s
Rule-making Form SBA-3c (6/02)
_
N
o
Title of Proposed Rule:
Rule-making#:
Change to County Reimbursement of Medical Exam (Med 9)
07-4-30-1
Program: Aging and Adult
Services/Aid to the Needy
Disabled Program
Rule Author: Susan Kern
Phone: 303-866-2810
STAKEHOLDER COMMENT SUMMARY
The following individuals and/or entities were contacted and informed that this rule-making was proposed:
Policy Advisory Committee-Aging and Adult Services (PAC-AAS) Subcommittee; Colorado Legal
Services; Colorado Coalition for the Homeless; Catholic Charities; Colorado Department of
Health Care, Policy and Financing
Comments were received from stakeholders on the proposed rule-making:
Yes
X
No
If “yes”, please summarize and/or attach the feedback you received:
9 CCR 2503-1
AID TO NEEDY DISABLED AND BLIND PERSONS
3.490.13 - 3.490.24
3.490.13
Responsibilities of the State Adult Financial Eligibility Unit
3.490.131
Administrative Monitoring of the State AND Program
Rev. eff .
8/1/05
The State Adult Financial Eligibility Unit shall monitor the administration of the State AND
program. It shall offer technical assistance to a county department requesting such.
3.490.132
Fiscal Sanctions for Overdue Redeterminations
Rev. eff.
8/1/05
The State Department shall withhold or recover financial reimbursement to the county
department concerning all cases in which redetermination forms are not completed by the
dates due. Such fiscal sanction shall, in the absence of good cause finding, be initiated
the month following the month in which overdue and for each month thereafter in which
the overdue submittal continues.
3.490.133
Waiver of Fiscal Sanctions
Rev. eff.
8/1/05
The above-described fiscal sanction may be waived, upon showing of good cause by the
county department including, but not limited to, physician's or other qualified medical
personnel as defined in Section 3.490.111 non-return of the State Department's
prescribed medical report form, acute illness of the recipient, or similar problems. In such
circumstances, however, the county department shall be responsible for appropriate
follow-up to correct the reason for delay.
3.490.2
ALLOWABLE MAXIMUM FOR MEDICAL EXAMINATION, TREATMENT, AND OTHER
FISCAL PROVISIONS
3.490.21
Payment for Medical Examinations
Rev. eff.
8/1/05
The county department shall authorize payment for examinations for State AND/AB
medical determination examinations. Fees and costs shall be reimbursed to the county
department at the rate of up to $22.50 maximum for general examinations and up to $75
maximum per special examination. USING THE 80% STATE SHARE, 20% COUNTY
SHARE.
3.490.22
Negotiated Fees FEE SETTING
Rev. eff.
8/1/05
The county department shall negotiate the fee with SET A FEE APPLICABLE TO
providers within the prescribed maximum as stated in Section 3.490.21, provide
appropriate forms, and shall make such payments in a timely manner.
3.490.23
Billings for Aid to the Blind Treatment Program
Rev. eff.
8/1/05
The billings for AB-T shall be reviewed and authorized by the State Department.
3.490.24
Add eff.
7/1/83
Negotiated Fees are Payment in Full
Providers shall accept fees for services as negotiated as payment in full. No individual
applicant or recipient shall be assessed any additional or supplementary fee.
THIS REVISION:
Adopted:
Effective Date:
III-05-1
6/3/2005
8/1/2005
LAST REVISION:
III-99-6
Adopted:
7/9/99
Effective Date:
6/4/99
COLORADO DEPARTMENT OF HUMAN SERVICES
STAFF MANUAL VOLUME 3
INCOME MAINTENANCE
REVISION NUMBER
3