VALLEY — After it passed in the Senate on Monday by 25-10 votes, the House passed Senate Bill 17-267 by 49-16 votes on the last of the Colorado General Assembly's session yesterday. Called "Concerning the Sustainability of Rural Colorado," the large bill reclassifies the hospital provider fee, gives money to rural schools, increases recreational marijuana taxes, funds roads, adjusts the Taxpayer Bill of Rights (TABOR) and more.

While all of those portions impact the San Luis Valley, enterprising the hospital provider fee saves local hospitals from closing or reducing services since it avoids $528 million in state budget cuts.

"We we're looking at between 3 and 4 million dollars per year in an immediate cut," said San Luis Valley Health CEO Konnie Martin. "That's some very real money in an organization of our size and we would be cutting essential services if that had happened."

All Colorado hospitals pay a fee, based on a formula of uninsured and Medicaid patients, to the federal government. That money is then pooled, matched and redistributed among the hospitals that have the highest number of uninsured and Medicaid patients using a different formula.

SLV Health receives an average of $7-8 million per year back from the provider fee.

The reimbursed funds were part of the state's general fund and subject to TABOR, but now that is no longer the case. Other examples of enterprised entities include Colorado Parks and Wildlife and the Colorado Lottery. The bill also lowers Department of Health Care Policy and Financing fee for the provider fee program from 5 percent to 3 percent. That extra money would go back to the hospitals in the program.   

Alamosa County Commissioners signed a letter in support of enterprising the provider fee back in early March. District 35 Sen. Larry Crowder and District 62 Rep. Donald Valdez both voted in support of the bipartisan bill, but it required a few compromises to pass.

"I'm grateful that we passed the Colorado healthcare affordability and sustainability enterprise bill as it protects rural hospitals while allowing support of Colorado roads, schools, senior citizens and small businesses," said Valdez in an email. "It's an imperfect compromise but a step in the right direction."

Crowder, who co-sponsored a failed hospital provider fee bill last year, was not keen on Colorado mortgaging state buildings with lease-purchase agreements to fund roads.

"There's not any bill you like 100 percent," he said. "You have to take the good with the bad.

"I can't say I'm against the leasing situation because it's so new to me that I don't quite understand it at this point in time, but if other states have been looking at it, then it might very well be a viable solution. I'm a little bit reluctant on that part but we'll have to see."

Another compromise increases prescription Medicaid co-pays from $1.25 to $2.50, the maximum federally allowed. Outpatient services were also doubled.

"Even though they're going to increase," Martin said, "we think they're very reasonable and we'll always work with patients who are in urgent situations.

"The bill has a lot of important moving parts to help it gain support it needed to get through the legislature and I see that as a very minor component."

Though Valley-Wide is not a hospital and therefore unaffected by the enterprise, it is also affected by the rise in co-pays.

"We were hoping that there wouldn't be an increase in co-pays for our Medicaid patients," said Valley-Wide Chief Administrative Officer Alonzo Payne, "but if that's the price to pay to ensure that we have our hospitals, those are the deals that they make up in the legislature."

Some Republicans would only vote for enterprising the fee if the TABOR spending cap was reduced by $200 million to compensate for the loss in general fund revenue. The state is already roughly $400 million below the cap, but Democrats argue that the compromise could affect economic growth down the line.

The bill is expected to be signed into law by Governor John Hickenlooper soon.

"Last year I was the only Republican senator to vote for it," Crowder said. "Things have changed. It takes time for people to understand the problems we have in rural Colorado."

Rio Grande Hospital could not be reached for comment.