Colorado Nursing Facility Provider Fees: Reconcile Assessments and Supplemental Payments

Colorado’s nursing facility financing can produce several cash movements outside the ordinary claim remittance. Netting them into one monthly number obscures whether the fee was paid, a supplemental installment is missing or a performance estimate was never earned. The controller needs a gross-to-net reconciliation with distinct evidence for every component.

The current reimbursement rule describes the fee and supplemental-payment mechanics. SB25-270 moved the fee framework into CHASE beginning May 1, 2025. HB23-1228 established changes including the 2026 performance-payment milestone. Read historical worksheets in light of those later provisions.

Establish the fee population

The Class I rule calculates the annual fee using non-Medicare patient days and the applicable per diem fee. It includes specific exemptions and reduced-fee treatment, so facility status and day counts matter. Maintain evidence of the relevant prior calendar-year population and any state-authorized estimate.

Use the current assessment notice for the dollar rate and installment. This guide does not supply a statewide current fee amount or a facility-specific award. Those amounts cannot be inferred from the public legislative summary, and a prior-year amount should not become an evergreen system default.

Build an original annual bridge

Assume a fictional nonexempt facility has an assessed annual fee of $360,000. Its supported Medicaid utilization percentage is 60%. Under the rule’s utilization formula, the illustrative utilization supplemental is $216,000. Assume separate final state notices support $240,000 of core and acuity-related supplementals and $60,000 of P4P payments.

The supported annual net is $156,000. Cash net to date is $143,000. Remaining supported receipts of $43,000 less the remaining $30,000 fee produce a $13,000 bridge. Both statements reconcile: $143,000 + $13,000 = $156,000.

The facility still has a $30,000 obligation even though its net position is positive. A receivable from one component should not be treated as permission to withhold a separately assessed fee.

Correct an estimate without inventing an award

Suppose the budget originally assumed $80,000 of P4P. The final supported notice is $60,000. Reduce the forecast by $20,000 and retain the reason. Do not leave the missing $20,000 in accounts receivable as though the state owes it.

The rule’s SFY 2026–27 P4P floor is at least 15% of aggregate annual provider-fee supplemental payments across Class I facilities. It does not give each facility a 15% return on its fee. Facility performance and the state calculation remain necessary.

Now assume a later state reconciliation adds $12,000 to the fee obligation. Record the revised notice, affected year and installment treatment, then reduce the supported net to $144,000 unless another confirmed adjustment changes it. Do not automatically increase the utilization supplemental by $7,200 merely because 60% of $12,000 equals that amount; verify whether and how the state’s revised calculation applies.

Preserve the payment hierarchy and timing

Colorado’s rule gives supplemental components a funding order, including utilization, acuity-adjusted core, P4P and other specified components before the core-component supplemental. The annual reconciliation can affect later fees or payments when available funds differ. A forecast therefore needs the state calculation and component identity, not only a total expected deposit.

Track each notice’s assessment period, due date, installment, payment reference, effective revision and receipt. An amount earned for one state fiscal year may arrive in another accounting period. Retain that bridge instead of assigning all cash to the month received.

Make the financial result reviewable

The completed package reconciles day inputs, facility status, assessed fee, each supported supplemental, cash and revisions. Unapproved performance estimates remain visible as scenarios. The controller can then decide which balance is payable, which is a supported receivable and which needs a state inquiry.

For a platform evaluation, introduce the $20,000 award reduction and the separate $12,000 fee true-up. Require the system to preserve the original notices and recalculate the net without offsetting away either gross balance. That tests the state-specific financial job a full-platform buyer needs to manage.