C.R.S. § 25.5-3-504 — CO Code / Title 25.5 / Article 3 / Part 5 / Section 25.5-3-504
25.5-3-504. Notification of patients' rights
Status: in_force

25.5-3-504. Notification of patients' rights. (1) Beginning September 1, 2022, a health-care facility shall make information developed by the state department about patients' rights under this part 5 and the uniform application developed by the state department pursuant to section 25.5-3-505 (2)(i) available to the public and to each patient. At a minimum, the health-care facility shall:

(a) Post the information in all required languages pursuant to this subsection (1) conspicuously on the health-care facility's website, including a link to the information on the health-care facility's main landing page;

(b) Make the information available in patient waiting areas;

(c) Make the information available to each patient, or the patient's legal guardian, verbally, which may include using a professional interpretation service, or in writing in the patient's or legal guardian's primary language before the patient is discharged from the health-care facility; and

(d) Inform each patient on the patient's billing statement of the patient's rights pursuant to this part 5, including the right to apply for discounted care, and provide the website, e-mail address, and telephone number where the information may be obtained in the patient's primary language.
C.R.S. § 25.5-1-602 — CO Code / Title 25.5 / Article 1 / Part 6 / Section 25.5-1-602
25.5-1-602. Commission created - composition - terms of office
Status: in_force

25.5-1-602. Commission created - composition - terms of office. (1) There is created, in the department of health care policy and financing, the commission on family medicine, referred to in this part 6 as the "commission". The commission consists of the following members:

(a) The deans of accredited allopathic and osteopathic schools of medicine in the state or their designated representatives;

(b) The director of all family medicine programs in the state accredited by the accreditation council on graduate medical education of the American medical association or the American osteopathic association;

(c) A representative of the Colorado academy of family physicians; and

(d) A health-care consumer to be appointed by the governor from each congressional district in the state. No more than a minimum majority of the members of the commission appointed by the governor pursuant to this subsection (1)(d) may be affiliated with the same political party. A vacancy on the commission occurs whenever any health-care consumer member moves out of the congressional district from which the member was appointed. A health-care consumer member who moves out of the congressional district shall promptly notify the governor of the date of the move, but notice is not necessary for the vacancy to occur. The governor shall fill the vacancy in accordance with subsection (2) of this section.

(2) The members appointed under subsection (1)(d) of this section serve three-year terms. All members serve at the pleasure of the governor. The governor shall fill any vacancy by appointment for the remainder of the unexpired term.

(3) The commission shall elect a chairperson and a vice-chairperson from among its members. Members of the commission serve without compensation, but members described in subsections (1)(b), (1)(c), and (1)(d) of this section are entitled to their actual and necessary expenses incurred in the performance of their duties. The commission shall meet on call of the chairperson, but not less than once every three months. A majority of the members of the commission constitutes a quorum for the transaction of business.
C.R.S. § 25.5-10-225 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-225
25.5-10-225. Right to vote
Status: in_force

25.5-10-225. Right to vote. Each person receiving services who is eligible to vote according to law has the right to vote in all primary and general elections. As necessary, all service agencies shall assist such persons to register to vote, to obtain mail ballots, to comply with other requirements that are prerequisite to voting, and to vote.
C.R.S. § 25.5-10-211.5 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-211.5
25.5-10-211.5. Conflict-free case management - implementation - legislative declaration - defin
Status: repealed

25.5-10-211.5. Conflict-free case management - implementation - legislative declaration - definition - repeal. (Repealed)
C.R.S. § 25.5-5-424 — CO Code / Title 25.5 / Article 5 / Part 4 / Section 25.5-5-424
25.5-5-424. Residential and inpatient substance use disorder treatment - MCE standardized ut
Status: in_force

25.5-5-424. Residential and inpatient substance use disorder treatment - MCE standardized utilization management process - medical necessity - report. (1) On or before October 1, 2021, the state department shall consult with the behavioral health administration in the department of human services, residential treatment providers, and MCEs to develop standardized utilization management processes to determine medical necessity for residential and inpatient substance use disorder treatment. The processes must incorporate the version of "The ASAM Criteria" used by the state department and align with federal medicaid payment requirements.

(2) On or before January 1, 2022, the state department shall incorporate the standards developed pursuant to subsection (1) of this section into existing MCE contracts, and each MCE shall adhere to the standards when conducting utilization management for residential and inpatient substance use disorder treatment.

(3) On or before January 1, 2022, each MCE's notice of an adverse benefit determination must demonstrate how each dimension of the version of "The ASAM Criteria" used by the state department was considered when determining medical necessity.

(4) (a) Beginning July 1, 2024, and quarterly thereafter, the state department shall report on the residential and inpatient substance use disorder utilization management statistics on the state department's website.

(I) to (III) (Deleted by amendment, L. 2024.)

(b) (Deleted by amendment, L. 2024.)

(c) Any information reported pursuant to subsection (4)(a) of this section may be aggregated as necessary to ensure confidentiality pursuant to 42 CFR part 2.
C.R.S. § 25.5-6-1304 — CO Code / Title 25.5 / Article 6 / Part 13 / Section 25.5-6-1304
25.5-6-1304. Repeal of part
Status: repealed

25.5-6-1304. Repeal of part. This part 13 is repealed, effective September 1, 2025.
C.R.S. § 25.5-3-102 — CO Code / Title 25.5 / Article 3 / Part 1 / Section 25.5-3-102
25.5-3-102. Legislative declaration
Status: in_force

25.5-3-102. Legislative declaration. (1) The general assembly hereby determines, finds, and declares that:

(a) The state has insufficient resources to pay for all medical services for persons who are indigent and must therefore allocate available resources in a manner that will provide treatment of those conditions constituting the most serious threats to the health of such medically indigent persons, as well as increase access to primary medical care to prevent deterioration of the health conditions among medically indigent people; and

(b) Such allocation of resources will require the prioritization of medical services by providers and the coordination of administration and delivery of medical services.

(2) The general assembly further determines, finds, and declares that the eligibility of medically indigent persons to receive medical services rendered under the conditions specified in subsection (1) of this section exists only to the extent of available appropriations, as well as to the extent of the individual provider facility's physical, staff, and financial capabilities. The general assembly also recognizes that the program for the medically indigent is a partial solution to the health-care needs of Colorado's medically indigent citizens. Therefore, medically indigent persons accepting medical services from such program shall be subject to the limitations and requirements imposed in this part 1.
C.R.S. § 25.5-1-903 — CO Code / Title 25.5 / Article 1 / Part 9 / Section 25.5-1-903
25.5-1-903. Failure to comply with hospital price transparency laws - prohibiting collection
Status: in_force

25.5-1-903. Failure to comply with hospital price transparency laws - prohibiting collection of debt - penalty. (1) A hospital that is not in material compliance with hospital price transparency laws on the date that items or services are purchased from or provided to a patient by the hospital shall not initiate or pursue a collection action against the patient or patient guarantor for a debt owed for the items or services.

(2) If a patient believes that a hospital was not in material compliance with hospital price transparency laws on the date that items or services were purchased by or provided to the patient, and the hospital takes a collection action against the patient or patient guarantor, the patient or patient guarantor may file suit to determine if:

(a) The hospital was materially out of compliance with hospital price transparency laws, rules, or regulations on the date the items or services were provided; and

(b) The noncompliance is related to the items or services. The hospital shall not take a collection action against the patient or patient guarantor while the lawsuit is pending.

(3) If a judge or jury, considering compliance standards issued by the federal centers for medicare and medicaid services, finds a hospital to be materially out of compliance with hospital price transparency laws, rules, or regulations, the hospital shall:

(a) Refund the payer any amount of the debt the payer has paid and shall pay a penalty to the patient or patient guarantor in an amount equal to the total amount of the debt;

(b) Dismiss or cause to be dismissed any court action with prejudice and pay any attorney fees and costs incurred by the patient or patient guarantor relating to the action;

(c) Remove or cause to be removed from the patient's or patient guarantor's credit report any report made to a consumer reporting agency relating to the debt; and

(d) Notify the state department of the material noncompliance with hospital price transparency laws, rules, or regulations.

(4) Nothing in this part 9:

(a) Prohibits a hospital from billing a patient, patient guarantor, or third-party payer, including a health insurer, for items or services provided to the patient; or

(b) Requires a hospital to refund any payment made to the hospital for items or services provided to the patient, so long as no collection action is taken in violation of this part 9.
C.R.S. § 25.5-10-305 — CO Code / Title 25.5 / Article 10 / Part 3 / Section 25.5-10-305
25.5-10-305. Authorized family support services
Status: in_force

25.5-10-305. Authorized family support services. (1) The family support services included in this program include, but are not limited to, family support grants, family support services coordination, information and referral, educational materials, emergency and outreach services, and other person- and family-centered assistance services such as:

(a) Medical and dental expenses not covered by medical or health insurance or other programs;

(b) Insurance expenses;

(c) Respite;

(d) Mobility aids; adaptive equipment; assistive technology, including the cost of therapies essential for a child's development, as prescribed by a physician or specialized therapist; and home adaptations;

(e) Home health services and therapies;

(f) Family counseling, training, and support groups;

(g) Recreation and leisure needs;

(h) Transportation;

(i) Special diets, clothing, materials, and equipment; and

(j) Homemaker services.
C.R.S. § 25.5-6-601 — CO Code / Title 25.5 / Article 6 / Part 6 / Section 25.5-6-601
25.5-6-601. Short title
Status: in_force

25.5-6-601. Short title. The short title of this part 6 is the "Home- and Community-based Services for Persons with Major Mental Health Disorders Act".
C.R.S. § 25.5-5-420 — CO Code / Title 25.5 / Article 5 / Part 4 / Section 25.5-5-420
25.5-5-420. Advancing care for exceptional kids
Status: in_force

25.5-5-420. Advancing care for exceptional kids. Within one hundred twenty days of the enactment of the federal "Advancing Care for Exceptional Kids Act", subject to available appropriations, the state department shall seek any federal approval necessary to fund, in cooperation with hospitals that meet the specified requirements, the implementation of an enhanced pediatric health home for children with complex medical conditions. Requirements for participation by the state department, along with the requirement of an enhanced pediatric health home, are stipulated by the "Advancing Care for Exceptional Kids Act" and shall be complied with accordingly.
C.R.S. § 25.5-4-308 — CO Code / Title 25.5 / Article 4 / Part 3 / Section 25.5-4-308
25.5-4-308. False medicaid claims jurisdiction
Status: in_force

25.5-4-308. False medicaid claims jurisdiction. An action under section 25.5-4-306 may be brought in any judicial district in which the defendant or, in the case of multiple defendants, any one defendant can be found, resides, or transacts business or in which an act proscribed by section 25.5-4-305 occurred. A summons as required by the Colorado rules of civil procedure shall be issued by the appropriate district court and served at any place.
C.R.S. § 25.5-1-204.7 — CO Code / Title 25.5 / Article 1 / Part 2 / Section 25.5-1-204.7
25.5-1-204.7. All-payer health claims database - creation of tool for review of data included
Status: in_force

25.5-1-204.7. All-payer health claims database - creation of tool for review of data included in the database - definitions. (1) As used in this section, unless the context otherwise requires:

(a) "Administrator" means the administrator of the all-payer health claims database.

(b) "All-payer health claims database" or "database" means the all-payer health claims database created pursuant to section 25.5-1-204.

(c) "Code" means CPT code, HCPCS code, or other packaged services or industry standard procedure code that may include time units, base unit values, or modifiers.

(d) "CPT code" means the current procedural terminology code, or its successor code, as developed and copyrighted by the American Medical Association or its successor entity.

(e) "Healthcare common procedure coding system code" or "HCPCS code" means the code established by the federal centers for medicare and medicaid services' alpha-numeric editorial panel for identifying health-care services in a consistent and standardized manner.

(f) "Private health-care payer" means a carrier, as defined in section 10-16-102 (8), that reports claims received from an out-of-network provider pursuant to section 12-30-113 (4).

(g) "Tool" means the tool developed by the administrator pursuant to this section to enable users to review certain health claims reimbursement data in the database.

(2) (a) To facilitate the accurate determination of the reimbursement rates pursuant to sections 10-16-704 (3)(d) and (5.5)(b), 12-30-113 (4), and 25-3-122 (3) and to provide transparency in the process, subject to available appropriations, the administrator shall create and maintain a tool for implementation by January 1, 2023, that enables users to review certain health claims reimbursement data included in the all-payer health claims database. The tool must include 2018 health claims reimbursement data as the first year of data.

(b) To the extent practicable, the tool must, at a minimum:

(I) Include twenty-fifth, fiftieth, sixtieth, and seventy-fifth percentile of in-network reimbursement rates based on claims and the number of claims submitted for each code by payer type, for all codes with sufficient volume reported to the database, for three years of data; and

(II) Be viewable and searchable by:

(A) Year;

(B) County;

(C) Geographic rating area and statewide;

(D) Payer type, including medicaid, medicare, and private health-care payers;

(E) Setting, including inpatient and outpatient services; and

(F) Specialty.

(c) The administrator shall ensure that the viewing or reporting of health claims data through the tool complies with all state and federal data privacy laws and antitrust laws.

(3) Subject to available appropriations, the administrator shall update the tool annually and may update the tool more frequently as determined by the administrator.
C.R.S. § 25.5-1-802 — CO Code / Title 25.5 / Article 1 / Part 8 / Section 25.5-1-802
25.5-1-802. Medicaid transportation services - safety and oversight - rules
Status: in_force

25.5-1-802. Medicaid transportation services - safety and oversight - rules. (1) The state department shall collaborate with stakeholders, including, but not limited to, disability and consumer advocates, PACE providers operating pursuant to section 25.5-5-412, transportation brokers, and transportation providers, to establish rules and processes for the safety and oversight of nonmedical transportation services and nonemergency medical transportation services provided to medicaid members pursuant to articles 4 to 6 of this title 25.5. The rules and processes must:

(a) Ensure the safety of passengers;

(b) Protect passenger access to transportation services; and

(c) Establish driver and vehicle requirements that minimize financial and administrative burdens for transportation providers, direct support professionals as defined in section 25.5-6-406, long-term care direct care workers, independent contractors, and employees providing transportation services.

(2) To the extent possible, the state department shall use existing oversight procedures to ensure compliance with the requirements as described in subsection (1) of this section.

(3) If a provider of transportation services already complies with transportation safety standards established by another state department which meet or exceed the rules and processes established pursuant to subsection (1) of this section, demonstrating such compliance to the state department is sufficient to verify compliance with the requirements of this section.
C.R.S. § 25.5-1-132 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-132
25.5-1-132. Report of medicaid reimbursement rates paid to community mental health center pr
Status: in_force

25.5-1-132. Report of medicaid reimbursement rates paid to community mental health center providers and independent providers - definition. (1) On or before August 15, 2022, the state department shall publish a behavioral health rates report of medicaid reimbursement rates for providers of community mental health centers, as defined in section 27-66-101 (2), and independent mental health and substance abuse treatment providers, as described in subsection (2) of this section. The state department shall contract with an independent auditor to prepare the behavioral health rates report, as described in this subsection (1). The state department shall prepare, in coordination with the behavioral health rates report, a set of recommendations on creating equitable payment and payment models that minimize inappropriate payment variation in comparable behavioral health services between the providers of community mental health centers and independent mental health and substance use treatment providers. The state department shall present the behavioral health rates report and recommendations to the house of representatives public and behavioral health and human services committee, or any successor committee.

(2) The report prepared pursuant to subsection (1) of this section must reflect data from state fiscal year 2020-21 and identify discrepancies, if any, and the reasons for such discrepancies in medicaid reimbursement rates paid to providers of a community mental health center and independent mental health and substance abuse treatment providers for comparable services. The report must include a determination of and recommendations on whether reimbursement rates paid to community mental health center providers and independent mental health and substance use treatment providers are adequate to meet or exceed network adequacy standards in every region of the state. The data must be aggregated to ensure individual community mental health centers and independent providers are not identifiable and must comply with any other state and federal privacy laws. On or before November 15, 2022, the state department shall present an action plan for implementation to the joint budget committee. The state department shall produce a progress report on the state department's progress made in implementing the action plan presented to the joint budget committee on November 15, 2022, on or before August 1, 2023, and annually thereafter through August 1, 2025, and provide an update during its "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" hearing pursuant to section 2-7-203 on the findings and additional recommendations. The state department must fully implement the action plan no later than December 31, 2025.

(3) As used in this section, unless the context otherwise requires, "independent mental health and substance abuse treatment providers" means any outpatient behavioral health provider enrolled in medicaid and contracted with a managed care entity, as defined in section 25.5-5-403 (4), that is not licensed or designated as a community mental health center.
C.R.S. § 25.5-3-303 — CO Code / Title 25.5 / Article 3 / Part 3 / Section 25.5-3-303
25.5-3-303. Consultation
Status: in_force

25.5-3-303. Consultation. At least annually, the state department shall consult with representatives of federally qualified health centers, school-based health centers, family residency directors, certified rural health clinics, other qualified providers, and consumer advocates regarding the implementation and administration of the allocation of moneys to qualified providers under this part 3.
C.R.S. § 25.5-6-116 — CO Code / Title 25.5 / Article 6 / Part 1 / Section 25.5-6-116
25.5-6-116. Community placement transformation - creation - report - repeal
Status: repealed

25.5-6-116. Community placement transformation - creation - report - repeal. (1) The state department shall undertake efforts to transform the state department's process for members or applicants attempting to receive long-term care in the community.

(2) In order to affirm Colorado's commitment to the United States supreme court's decision in Olmstead v. L.C., 527 U.S. 581 (1999), and to the federal "Americans with Disabilities Act of 1990", 42 U.S.C. sec. 12101 et seq., as amended, and respond to the United States department of justice's letter of findings, dated March 3, 2022, concerning the investigation of Colorado's use of nursing facilities to serve adults with physical disabilities, the general assembly shall appropriate money to the state department in order to advance community placement and integration for individuals with disabilities.

(3) No later than January 2023, and January 2024, the state department shall report to the joint budget committee, the house of representatives public and behavioral health and human services committee, and the senate health and human services committee, or their successor committees, as part of its "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" hearing required by section 2-7-203. At a minimum, the report must include an analysis and recommendations on the following:

(a) The state department's work and strategic planning regarding fulfilling Colorado's commitment to the Olmstead decision to ensure community living;

(b) Programmatic decisions, analysis, and policy changes in accordance with the federal "Americans with Disabilities Act of 1990", 42 U.S.C. sec. 12101 et seq., as amended; and

(c) Information regarding the state department's coordination, programmatic or medicaid benefit changes, implementation of quality oversight strategies, and metrics around community integration.

(4) This section is repealed, effective July 1, 2025.
C.R.S. § 25.5-10-301 — CO Code / Title 25.5 / Article 10 / Part 3 / Section 25.5-10-301
25.5-10-301. Legislative declaration
Status: in_force

25.5-10-301. Legislative declaration. (1) It is the intent of the general assembly that the service delivery system for persons with intellectual and developmental disabilities emphasize community living for persons with intellectual and developmental disabilities and provide supports to persons that enable them to enjoy typical lifestyles. One way to accomplish this is to recognize that families are the greatest resource available to persons who have an intellectual and developmental disability and that families must be supported in their role as primary care givers. The general assembly finds that supporting families in their effort to provide supports for their family members at home is more efficient, cost-effective, and humane than maintaining persons with intellectual and developmental disabilities in out-of-home residential settings. In recognition of the importance of families, the general assembly states that the following principles should be used as guidelines in developing programs to support a family that has a child with disabilities:

(a) Families of persons with intellectual and developmental disabilities are best able to determine their own needs and preferences and should be empowered to make decisions concerning necessary, desirable, and appropriate services and supports;

(b) Families must receive the services and supports necessary to care for their children at home;

(c) Family support must be responsive to the needs of the entire family unit;

(d) Family support must be sensitive to the unique strengths and needs of individual families;

(e) Family support must build on existing social networks and natural sources of support;

(f) Family support is needed throughout the life span of the person who has a disability;

(g) Family support must encourage the inclusion of people with intellectual and developmental disabilities within the community;

(h) Family support services must be flexible enough to accommodate unique needs of families as they evolve over time;

(i) Family support services must be consistent with the cultural preferences and orientations of individual families;

(j) Family support services should be comprehensive and coordinated across the numerous agencies likely to provide resources, supports, or services to families;

(k) Family support services should be based on the principles of sharing ordinary places, developing meaningful relationships, learning things that are useful, making choices, as well as increasing the status and enhancing the reputation of people served;

(l) Supports should be developed by the state that are necessary, desirable, and appropriate to support families;

(m) Intellectual and developmental disabilities programs and policies must enhance the development of the person with an intellectual and developmental disability and the family;

(n) State programs should provide sufficient services and supports to enable families to keep their family members with intellectual and developmental disabilities at home;

(o) A comprehensive, coordinated system of supports to families effectively uses existing resources and minimizes gaps in supports to families and persons in all areas of the state;

(p) Services and supports provided through the family support program must be closely coordinated with early intervention services and must foster collaboration and cooperation with all agencies providing services and supports to infants and preschool children; and

(q) Any rights, entitlements, services, or supports created by this part 3 are not to be considered a limitation, modification, or infringement on any existing rights, entitlements, services, or supports, otherwise expressly provided by this article.

(2) In addition, the general assembly recognizes that the state department has for several years developed and maintained a family resource service program that provides support services to families of children with intellectual and developmental disabilities who are at risk of out-of-home placement. Because of the success of this program the general assembly recommends that this valuable program be continued and expanded so that more families in this state are able to receive appropriate services, supports, and assistance needed to stabilize the family unit. In recognition of the basic goal to support families, on an individual family basis, in maintaining a person with an intellectual and developmental disability at home and in recognition of the principles stated in subsection (1) of this section, the general assembly declares that its purpose in enacting this part 3 is to create, subject to annual appropriation, a comprehensive statewide family support service program.
C.R.S. § 25.5-1-103 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-103
25.5-1-103. Definitions
Status: in_force

25.5-1-103. Definitions. As used in this title 25.5, unless the context otherwise requires:

(1) "County board" means the county or district board of human or social services; except that, in the city and county of Denver, "county board" means the department or agency with the responsibility for public assistance and welfare activities, and, in the city and county of Broomfield, "county board" means the city council or a board or commission with the responsibility for public assistance and welfare activities appointed by the city and county of Broomfield.

(2) "County department" means the county or district department of human or social services.

(3) "County director" means the director of the county or district department of human or social services.

(4) "Executive director" means the executive director of the department of health care policy and financing.

(5) "Medical assistance" means any program administered by the state department, including but not limited to the "Colorado Medical Assistance Act", as specified in articles 4, 5, and 6 of this title, the "Children's Basic Health Plan Act", article 8 of this title, the old age pension health and medical care program, and the supplemental old age pension health and medical care program; except that "medical assistance" for purposes of articles 4, 5, and 6 of this title shall have the meaning as defined in section 25.5-4-103 (13).

(5.5) "Medical home" means an appropriately qualified medical specialty, developmental, therapeutic, or mental health-care practice that verifiably ensures continuous, accessible, and comprehensive access to and coordination of community-based medical care, mental health care, oral health care, and related services for a child. A medical home may also be referred to as a health-care home. If a child's medical home is not a primary medical care provider, the child must have a primary medical care provider to ensure that a child's primary medical care needs are appropriately addressed. All medical homes shall ensure, at a minimum, the following:

(a) Health maintenance and preventive care;

(b) Anticipatory guidance and health education;

(c) Acute and chronic illness care;

(d) Coordination of medications, specialists, and therapies;

(e) Provider participation in hospital care; and

(f) Twenty-four-hour telephone care.

(6) "Member" means any person who has been determined eligible to receive benefits or services under this title 25.5.

(7) "State board" or "board" means the medical services board created pursuant to section 25.5-1-301.

(8) "State department" means the department of health care policy and financing.

(9) "State designated agency" means an agency designated to perform specified functions that would otherwise be performed by the county departments, including case management agencies, as defined in section 25.5-6-1702, and medical assistance sites.
C.R.S. § 25.5-8-113 — CO Code / Title 25.5 / Article 8 / Section 25.5-8-113
25.5-8-113. Reports by contractors to medical services board
Status: repealed

25.5-8-113. Reports by contractors to medical services board. (Repealed)
C.R.S. § 25.5-10-240 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-240
25.5-10-240. Retaliation prohibited
Status: in_force

25.5-10-240. Retaliation prohibited. No person shall be discriminated against because the person has made a complaint, testified, assisted, or participated in any manner in an investigation, proceeding, or hearing pursuant to this article 10, including the dispute resolution procedures in section 25.5-10-212 and section 27-10.5-107. A service agency, including the state department and any case management agency, shall not coerce, intimidate, threaten, or interfere with any person in the exercise or enjoyment of any right pursuant to this article 10, or on account of the person having exercised or enjoyed any right pursuant to this article 10, or on account of the person having aided or encouraged any other person in the exercise or enjoyment of any right pursuant to this article 10.
C.R.S. § 25.5-6-112 — CO Code / Title 25.5 / Article 6 / Part 1 / Section 25.5-6-112
25.5-6-112. Plan of financial operation - purpose - approval - financial audits - rules - re
Status: repealed

25.5-6-112. Plan of financial operation - purpose - approval - financial audits - rules - repeal. (Repealed)
C.R.S. § 25.5-2.5-201 — CO Code / Title 25.5 / Article 2.5 / Part 2 / Section 25.5-2.5-201
25.5-2.5-201. Short title
Status: in_force

25.5-2.5-201. Short title. The short title of this part 2 is the "Dr. Irene Aguilar Canadian Prescription Drug Importation Act".
C.R.S. § 25.5-1-204 — CO Code / Title 25.5 / Article 1 / Part 2 / Section 25.5-1-204
25.5-1-204. Advisory committee to oversee the all-payer health claims database - creation -
Status: repealed

25.5-1-204. Advisory committee to oversee the all-payer health claims database - creation - members - duties - legislative declaration - rules - report. (1) The general assembly hereby finds and declares that an advisory committee for the all-payer health claims database would support the database in its established mission of facilitating the reporting of health-care and health quality data that results in transparent and public reporting of safety, quality, cost, and efficiency information; and analysis of health-care spending and utilization patterns for purposes that improve the population's health, improve the care experience, and control costs.

(2) (a) No later than August 1, 2013, the executive director shall appoint an advisory committee to oversee the Colorado all-payer health claims database. The advisory committee shall include the following members:

(I) A member of academia with experience in health-care data and cost efficiency research;

(II) A representative of:

(A) A statewide association of hospitals;

(B) An integrated multi-specialty organization;

(C) Physicians and surgeons;

(D) An organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity;

(E) A nonprofit organization that demonstrates experience working with employers to enhance value and affordability in health insurance;

(F) Dental insurers;

(G) Pharmacists or an affiliate society;

(H) Pharmacy benefit managers;

(I) A statewide association of ambulatory surgical centers;

(III) A representative, who is not a supplier or broker of health insurance, of:

(A) Small employers that purchase group health insurance for employees;

(B) Large employers that purchase health insurance for employees;

(C) Self-insured employers;

(IV) A representative from a comprehensive community behavioral health provider, as defined in section 27-50-101, who has experience in behavioral health data collection;

(V) Three representatives with a demonstrated record of advocating health-care issues on behalf of consumers;

(VI) Two representatives of health insurers, one who represents nonprofit insurers and one who represents for-profit insurers;

(VII) Two representatives of nonprofit organizations that facilitate health information exchange to improve health care for all Coloradans;

(VIII) The executive director or his or her designee, serving as an ex officio member;

(IX) The commissioner of insurance or his or her designee, serving as an ex officio member;

(X) A representative of the department of personnel, serving as an ex officio member;

(XI) The director of the office of information and technology or his or her designee, serving as an ex officio member; and

(XII) Two members of the general assembly, one appointed by the majority leader of the senate and one appointed by the majority leader of the house of representatives; except that, if the majority leaders are from the same political party, the minority leader of the house of representatives shall appoint the second member. The two members of the general assembly shall serve as ex officio members.

(b) The advisory committee shall make recommendations to the executive director and the Colorado all-payer health claims database administrator related to the Colorado all-payer health claims database. The recommendations include the following:

(I) Procedures for the collection, retention, use, and disclosure of data from the Colorado all-payer health claims database, including procedures and safeguards to protect the privacy, integrity, confidentiality, and availability of any data;

(II) Guidelines for charging for custom reports from the Colorado all-payer health claims database;

(III) Procedures to ensure compliance with the "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended, and implementing federal regulations;

(IV) Procedures to ensure compliance with other state and federal privacy laws; and

(V) Procedures for data confidentiality and data disposal if the Colorado all-payer health claims database ceases to exist.

(c) The members of the advisory committee appointed pursuant to subparagraph (XII) of paragraph (a) of this subsection (2) are entitled to receive compensation and reimbursement of expenses as provided in section 2-2-326, C.R.S.

(3) (a) The administrator shall prepare and file annual reports to the legislature by March 1 of each year. The annual report must contain:

(I) The uses of the data in the all-payer health claims database;

(II) Public studies produced by the administrator;

(III) The cost of administering the Colorado all-payer health claims database, the sources of the funding, and the total revenue taken in by the database;

(IV) The recipients of the data, the purposes for the data requests, and whether a fee was charged for the data;

(V) A fee schedule displaying the fees for providing custom data reports from the Colorado all-payer health claims database.

(b) The executive director shall require an evaluation of the Colorado all-payer health claims database initiative every five years beginning in 2018, to ensure that the database accomplishes the goals of this section. The report must contain metrics that document and demonstrate the achievements or challenges of the program goals.

(c) (I) By November 15, 2022, and by each November 15 thereafter, subject to available appropriations, the administrator shall provide a primary care spending report to the commissioner of insurance for use by the primary care payment reform collaborative established in section 10-16-150 regarding primary care spending:

(A) By carriers, as defined in sections 10-16-102 (8) and 24-50-603 (2);

(B) Under the "Colorado Medical Assistance Act", articles 4, 5, and 6 of this title 25.5; and

(C) Under the "Children's Basic Health Plan Act", article 8 of this title 25.5.

(II) The report prepared in accordance with this subsection (3)(c) must include:

(A) The percentage of the medical expenses allocated to primary care;

(B) The share of payments that are made through nationally recognized alternative payment models and the share of payments that are not paid on a fee-for-service or per-claim basis; and

(C) Data related to the aligned quality measure set determined by the division of insurance in accordance with section 10-16-157 (3).

(4) (a) The administrator shall seek funding for the creation of the all-payer health claims database and develop a plan for the financial stability of the database. If sufficient funding is received through gifts, grants, and donations on or before January 1, 2012, as determined by the executive director, the administrator shall, in consultation with the advisory committee, create the Colorado all-payer claims database.

(b) The general assembly may annually appropriate general fund money to the state department to pay for expenses related to the all-payer health claims database.

(5) If sufficient funding is received, the executive director shall direct the administrator to create the database and the administrator shall:

(a) Determine the data to be collected from payers and the method of collection, including mandatory and voluntary reporting of health-care and health quality data;

(b) Seek to establish agreements for voluntary reporting of health-care claims data from health-care payers that are not subject to mandatory reporting requirements in order to ensure availability of the most comprehensive and systemwide data on health-care costs and quality;

(c) Seek to establish agreements or requests with the federal centers for medicare and medicaid services to obtain medicare health claims data;

(d) Determine the measures necessary to implement the reporting requirements in a manner that is cost-effective and reasonable for data sources and timely, relevant, and reliable for consumers, public and private purchasers, providers, and policymakers;

(e) Determine the reports and data to be made available to the public with recommendations from the advisory committee in order to accomplish the purposes of this section, including conducting studies and reporting the results of the studies;

(f) Collect, aggregate, distribute, and publicly report performance data on quality, health outcomes, health disparities, cost, utilization, and pricing in a manner accessible for consumers, public and private purchasers, providers, and policymakers;

(g) Protect patient privacy in compliance with state and federal medical privacy laws while preserving the ability to analyze data and share with providers and payers to ensure accuracy prior to the public release of information;

(h) Repealed.

(i) Provide leadership and coordination of public and private health-care quality and performance measurements to ensure efficiency, cost-effectiveness, transparency, and informed choice by consumers and public and private purchasers; and

(j) Subject to available appropriations and at the request of the commissioner of insurance, publish information to the public concerning dental loss ratio information collected by the division of insurance pursuant to section 10-16-165.

(6) The administrator, with input from the advisory committee:

(a) Shall incorporate and utilize publicly available data other than administrative claims data if necessary to measure and analyze a significant health-care quality, safety, or cost issue that cannot be adequately measured with administrative claims data alone;

(b) Shall require payer data sources to submit data necessary to implement the all-payer claims database;

(c) Shall determine the data elements to be collected, the reporting formats for data submitted, and the use and reporting of any data submitted. Data collection shall align with national, regional, and other uniform all-payer claims databases' standards where possible.

(d) May audit the accuracy of all data submitted;

(e) May contract with third parties to collect and process the health-care data collected pursuant to this section. The contract shall prohibit the collection of unencrypted social security numbers and the use of the data for any purpose other than those specifically authorized by the contract. The contract shall require the third party to transmit the data collected and processed under the contract to the administrator or other designated entity.

(f) May share data regionally or help develop a multistate effort if recommended by the advisory committee.

(7) The all-payer health claims database shall:

(a) Be available to the public when disclosed in a form and manner that ensures the privacy and security of personal health information as required by state and federal law, as a resource to insurers, consumers, employers, providers, purchasers of health care, and state agencies to allow for continuous review of health-care utilization, expenditures, and quality and safety performance in Colorado;

(b) Be available to state agencies and private entities in Colorado engaged in efforts to improve health care, subject to rules promulgated by the executive director;

(c) Be presented to allow for comparisons of geographic, demographic, and economic factors and institutional size;

(d) Present data in a consumer-friendly manner.

(8) The collection, storage, and release of health-care data and other information pursuant to this section is subject to the federal "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended.

(9) The executive director shall promulgate rules as necessary to implement this section, which rules shall include the assessment of a fine for a payer required to submit data that does not comply with this section. Any fines collected shall be deposited in the all-payer health claims database cash fund, which is hereby created in the state treasury. The moneys in the fund shall be appropriated to the department of health care policy and financing for the purpose of maintaining the all-payer health claims database. The moneys in the fund shall remain in the fund and not revert to the general fund or any other fund at the end of any fiscal year.

(10) Repealed.

(11) If at any time, there is not sufficient funding to finance the ongoing operations of the database, the database shall cease operating and the advisory committee and administrator shall no longer have the duty to carry out the functions required pursuant to this section. If the database ceases to operate, the data submitted shall be destroyed or returned to its original source.
C.R.S. § 25.5-5-334 — CO Code / Title 25.5 / Article 5 / Part 3 / Section 25.5-5-334
25.5-5-334. Community health worker services - federal authorization - reporting - rules - d
Status: in_force

25.5-5-334. Community health worker services - federal authorization - reporting - rules - definition. (1) As used in this section, unless the context otherwise requires, "community health worker" means a frontline public health worker who serves as a liaison between health-care providers or social service providers and community members in order to facilitate access to physical, behavioral, or dental health-related services, or services to address social determinants of health, and who improves the quality and cultural responsiveness of health-related service delivery.

(2) No later than July 1, 2024, the state department shall seek federal authorization from the federal centers for medicare and medicaid services to provide reimbursement for community health worker services including, but not limited to, the delivery of preventive services, group and individual health education and health coaching, health navigation, transitions of care supports, screening and assessment for nonclinical and social needs, and individual support and health advocacy.

(3) Prior to seeking federal authorization, the state department shall hold at least four public stakeholder meetings to facilitate public engagement and solicit input from relevant stakeholders on the development of the required elements for federal authorization. Relevant stakeholders include, but are not limited to, community health workers, representatives from a statewide group representing community health workers, consumer advocates, local public health agencies, public health nonprofits and institutes, representatives from Colorado department of public health and environment-recognized training programs for health navigators and community health workers, health-care providers, managed care entities, representatives from schools and school-based health centers, and the Colorado department of public health and environment. At a minimum, the state department shall seek input from stakeholders regarding:

(a) Ways to ensure community health workers serve to reduce health disparities and increase health equity;

(b) Minimum qualifications for community health workers, such as training and skills-based experience requirements;

(c) Methods for minimizing the burden of entering into the community health workforce;

(d) A patient safety monitoring responsibilities and grievance process;

(e) What services provided by a community health worker will be considered covered services and noncovered services;

(f) Processes and requirements regarding provider types, provider enrollment, billing codes, places of service, and any other operational component necessary for implementation in the medicaid management information system;

(g) Reimbursement using the fee-for-service managed care or values-based payment models for community health workers with consideration of the use of alternative payment methodologies in the future;

(h) New provider types that could facilitate community health worker services outside of traditional health-care settings, such as community-based organizations; and

(i) Clarification on community health workers' role and scope of practice as part of a delivery system that may include case management, care management, and care coordination services provided by managed care entities, community-centered boards, single entry points, behavioral health administrative service organizations, case management agencies, and health-care providers.

(4) In consideration of opportunities for future expansion of the community health worker workforce, the Colorado department of public health and environment is encouraged to partner with the state department and stakeholders to make recommendations for training and competency standards related to specialization that would enable community health workers to specialize their work with different populations and health conditions.

(5) Costs associated with services provided by community health workers through a federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4), are considered allowable costs for the purposes of a federally qualified health center's cost report. The state department shall work with stakeholders to determine how services provided by community health workers will be captured in federally qualified health centers' cost reports.

(6) Costs associated with services provided by community health workers through a rural health clinic, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2), are considered allowable costs for the purposes of a rural health clinic's cost report. The state department shall work with stakeholders to determine how services provided by community health workers will be captured in rural health centers' cost reports.

(7) The state department shall consult with the Colorado department of public health and environment in promulgating rules concerning the voluntary competency-based community health worker registry managed by the Colorado department of public health and environment and any additional criteria or standards that may be necessary.

(8) For purposes of medicaid reimbursement, a community health worker shall:

(a) Work under the supervision of a clinician or within a licensed or otherwise approved and medicaid-enrolled health provider agency; and

(b) Meet the minimum qualifications and credentialing requirements of the voluntary competency-based community health worker registry as defined in section 25-20.5-112.

(9) The state department shall ensure that reimbursement policies and federal authorities for existing unlicensed health workers, such as peer support professionals, recovery professionals, managed care navigation staff, and others, are aligned and incorporated with the community health worker payment models.

(10) On or before January 31, 2026, the state department shall report on ways community health workers are being utilized through the state medical assistance program and include available data or any identified costs or savings associated with community health worker services and considerations for the general assembly to expand community health worker services in community-based organizations that are outside of the traditional health-care setting in its presentation to the joint budget committee of the general assembly and in its presentation to the health and human services committee of the senate and the health and insurance committee of the house of representatives, or any successor committees, at the hearing held pursuant to section 2-7-203 (2)(a) of the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act".
C.R.S. § 25.5-1-902 — CO Code / Title 25.5 / Article 1 / Part 9 / Section 25.5-1-902
25.5-1-902. Definitions
Status: in_force

25.5-1-902. Definitions. As used in this part 9, unless the context otherwise requires:

(1) "Collection action" means any of the following actions taken with respect to a debt for items and services that were purchased from or provided to a patient by a hospital on a date during which the hospital was not in material compliance with hospital price transparency laws:

(a) Attempting to collect a debt from a patient or patient guarantor by referring the debt, directly or indirectly, to a debt collector, a collection agency, or other third party retained by or on behalf of the hospital;

(b) Suing the patient or patient guarantor or enforcing an arbitration or mediation clause in any hospital documents, including contracts, agreements, statements, or bills; or

(c) Directly or indirectly causing a report to be made to a consumer reporting agency.

(2) (a) "Collection agency" means any:

(I) Person who engages in a business, the principal purpose of which is the collection of debts; or

(II) Person who:

(A) Regularly collects or attempts to collect, directly or indirectly, debts owed or due or asserted to be owed or due to another;

(B) Takes assignment of debts for collection purposes;

(C) Directly or indirectly solicits for collection debts owed or due or asserted to be owed or due to another; or

(D) Collects debt for the department of personnel.

(b) "Collection agency" does not include:

(I) Any officer or employee of a creditor while, in the name of the creditor, collecting debts for such creditor;

(II) Any person while acting as a collection agency for another person, both of whom are related by common ownership or affiliated by corporate control, if the person acting as a collection agency does so only for creditors to whom it is so related or affiliated and if the principal business of the person is not the collection of debts;

(III) Any officer or employee of the United States or any state to the extent that collecting or attempting to collect any debt is in the performance of the officer's or employee's official duties;

(IV) Any person while serving or attempting to serve legal process on any other person in connection with the judicial enforcement of any debt;

(V) Any debt-management services provider operating in compliance with or exempt from the "Uniform Debt-Management Services Act", part 2 of article 19 of title 5;

(VI) Any person collecting or attempting to collect any debt owed or due or asserted to be owed or due another to the extent that:

(A) The activity is incidental to a bona fide fiduciary obligation or a bona fide escrow arrangement;

(B) The activity concerns a debt that was extended by the person;

(C) The activity concerns a debt that was not in default at the time it was obtained by the person; or

(D) The activity concerns a debt obtained by the person as a secured party in a commercial credit transaction involving the creditor;

(VII) Any person whose principal business is the making of loans or the servicing of debt not in default and who acts as a loan correspondent, seller and servicer for the owner, or holder of a debt that is secured by a deed of trust on real property, whether or not the debt is also secured by an interest in personal property; or

(VIII) A limited gaming or racing licensee acting pursuant to article 33 of title 44.

(c) Notwithstanding the provisions of subsection (2)(b) of this section, "collection agency" includes any person who, in the process of collecting the person's own debts, uses another name that would indicate that a third person is collecting or attempting to collect such debts.

(3) (a) "Consumer reporting agency" means any person that, for monetary fees or dues or on a cooperative nonprofit basis, regularly engages, in whole or in part, in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties. "Consumer reporting agency" includes any person defined in 15 U.S.C. sec. 1681a (f) or section 5-18-103 (4).

(b) "Consumer reporting agency" does not include any business entity that provides check verification or check guarantee services only.

(4) (a) "Debt" means any obligation or alleged obligation of a consumer to pay money arising out of a transaction, whether or not the obligation has been reduced to judgment.

(b) "Debt" does not include a debt for business, investment, commercial, or agricultural purposes or a debt incurred by a business.

(5) "Debt collector" means any person employed or engaged by a collection agency to perform the collection of debts owed or due or asserted to be owed or due to another.

(6) "Federal centers for medicare and medicaid services" or "CMS" means the centers for medicare and medicaid services in the United States department of health and human services.

(7) "Hospital" means, consistent with 45 CFR 180.20, a hospital:

(a) Licensed or certified by the department of public health and environment pursuant to section 25-1.5-103 (1)(a); or

(b) Approved by the department of public health and environment as meeting the standards established for licensing a hospital.

(8) "Hospital price transparency laws" means section 2718 (e) of the "Public Health Service Act", Pub.L. 78-410, as amended, and rules adopted by the United States department of health and human services implementing section 2718 (e).

(9) "Items and services" or "items or services" means "items and services" as defined in 45 CFR 180.20.
C.R.S. § 25.5-5-511 — CO Code / Title 25.5 / Article 5 / Part 5 / Section 25.5-5-511
25.5-5-511. Reimbursement for pharmacists' services - legislative declaration
Status: in_force

25.5-5-511. Reimbursement for pharmacists' services - legislative declaration. (1) (a) The general assembly finds and declares that:

(I) Pharmacists are highly trained and educated doctorate-level health-care professionals specializing in the effective use of medications and their outcomes;

(II) Pharmacists provide health care throughout the entire health-care system, practicing in community pharmacies, hospitals, provider clinic offices, and specialty areas;

(III) With ninety percent of Americans living within five miles of a pharmacy, pharmacists are able to provide valuable public health services to communities and to provide those services in novel ways, including during nontraditional hours and without appointments;

(IV) As part of an integrated team, pharmacists have been proven to lower the overall cost of health care and improve long-term chronic disease outcomes; however, despite these recognized benefits, pharmacists are not considered reimbursable medical providers;

(V) Further, pharmacists in integrated medical homes under the medical assistance program are not supported by the same funding mechanisms as other providers, including rate setting for federally qualified health centers or through fee-for-service billing;

(VI) Without the ability to generate revenue through direct reimbursement or new value-based models, the services pharmacists provide are not sustainable;

(VII) Colorado has recognized that there is a shortage in primary care providers for individuals enrolled in the medical assistance program; and

(VIII) Pharmacists can help address this shortage by providing certain primary care services as a follow-up to physician care through collaborative practice models, including the provision of chronic disease management.

(b) Therefore, the general assembly declares that the ability of pharmacists to generate revenue for the same services provided by other health-care providers would be equitable, would help fund staff and services in medical homes, and would alleviate barriers to access of care in community settings.

(2) (a) A pharmacist is eligible to receive reimbursement under the medical assistance program for medically necessary services authorized in part 6 of article 280 of title 12 that are not duplicative of other pharmacist services or programs reimbursed under the medical assistance program.

(b) The state department shall include the services reimbursed pursuant to subsection (2)(a) of this section in the review of provider rates required pursuant to section 25.5-4-401.5.

(3) The state department shall request any federal authorization necessary to receive federal financial participation under the medical assistance program.
C.R.S. § 25.5-4-432 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-432
25.5-4-432. Reimbursement guidance for screening, brief intervention, and referral to treatm
Status: in_force

25.5-4-432. Reimbursement guidance for screening, brief intervention, and referral to treatment. The state department shall publish guidance for providers concerning reimbursement for all variations of screening, brief intervention, and referral to treatment interventions.
C.R.S. § 25.5-4-303.5 — CO Code / Title 25.5 / Article 4 / Part 3 / Section 25.5-4-303.5
25.5-4-303.5. Short title
Status: in_force

25.5-4-303.5. Short title. This section and sections 25.5-4-304 to 25.5-4-310 shall be known and may be cited as the "Colorado Medicaid False Claims Act".
C.R.S. § 25.5-3-206 — CO Code / Title 25.5 / Article 3 / Part 2 / Section 25.5-3-206
25.5-3-206. Reports
Status: repealed

25.5-3-206. Reports. (Repealed)
C.R.S. § 25.5-10-237 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-237
25.5-10-237. Terminology
Status: in_force

25.5-10-237. Terminology. (1) Whenever the terms "insane", "insanity", "mentally or mental incompetent", "mental incompetency", or "of unsound mind" are used in the laws of the state of Colorado, they shall be deemed to refer to the insane, as defined in section 16-8-101, C.R.S., or to a person with an intellectual and developmental disability, as defined in section 25.5-10-202, as the context of the particular law requires.

(2) Whenever the term "mentally deficient person" is used in the laws of the state of Colorado, it shall be deemed to mean and be included with the term "person with an intellectual and developmental disability", as defined in section 25.5-10-202.
C.R.S. § 25.5-5-426 — CO Code / Title 25.5 / Article 5 / Part 4 / Section 25.5-5-426
25.5-5-426. Managed care entities - behavioral health providers - disclosure of reimbursemen
Status: in_force

25.5-5-426. Managed care entities - behavioral health providers - disclosure of reimbursement rates. (1) The state department shall require each MCE that contracts with the state department to disclose the aggregated average and lowest rates of reimbursement for a set of behavioral health services determined by the state department.

(2) Behavioral health providers are authorized to disclose the reimbursement rates paid by an MCE to the behavioral health provider.
C.R.S. § 25.5-3-506 — CO Code / Title 25.5 / Article 3 / Part 5 / Section 25.5-3-506
25.5-3-506. Limitations on collection actions - private enforcement
Status: in_force

25.5-3-506. Limitations on collection actions - private enforcement. (1) Beginning September 1, 2022, before assigning or selling patient debt to a collection agency, as defined in section 5-16-103 (3)(a), or a debt buyer, as defined in section 5-16-103 (8.5), or before pursuing, either directly or indirectly, any permissible extraordinary collection action, as defined in section 6-20-201 (7):

(a) A health-care facility shall meet the screening requirements in section 25.5-3-502;

(b) A health-care facility and licensed health-care professional shall provide discounted care to a patient pursuant to section 25.5-3-503;

(c) A health-care facility and licensed health-care professional shall provide a plain language explanation of the health-care services and fees being billed and notify the patient of potential collection actions; and

(d) A health-care facility and health-care professional shall bill any third-party payer that is responsible for providing health-care coverage to the patient. If a health-care professional is an out-of-network provider under a qualified patient's health insurance plan, the health-care professional and health insurance carrier shall comply with the out-of-network billing requirements described in sections 10-16-704 (3) and 12-30-113.

(2) A health-care facility or licensed health-care professional that fails to comply with the requirements of this section is liable to the patient in an amount equal to the sum of:

(a) Any actual damages sustained by the patient as a result of such failure;

(b) In the case of such action brought by an individual, any additional damages that the court may allow, not to exceed one thousand dollars;

(c) In the case of a class action, such amount for each named plaintiff that may recover damages under subsection (2)(b) of this section, and such amount that the court may allow for all other class members without regard to a minimum individual recovery, not to exceed the lesser of five hundred thousand dollars or one percent of the net worth of the health-care facility or licensed health-care professional; and

(d) In the case of any successful action to enforce the foregoing liability, the costs of the action together with reasonable attorney fees as determined by the court. On a finding by the court that the action was brought in bad faith, the court may award reasonable attorney fees to the defendant that are related to the work expended and costs.

(3) In determining the amount of liability in any action pursuant to subsection (2) of this section, the court shall consider, among other relevant factors:

(a) In any individual action brought pursuant to subsection (2)(a) of this section, the frequency and persistence of noncompliance by the health-care facility or licensed health-care professional, the nature of such noncompliance, and the extent to which such noncompliance was intentional; or

(b) In any individual action brought pursuant to subsection (2)(b) of this section, the frequency and persistence of noncompliance by the health-care facility or licensed health-care professional, the nature of such noncompliance, the resources of the health-care facility or licensed health-care professional, the number of individuals adversely affected, and the extent to which the health-care facility's or licensed health-care professional's noncompliance was intentional.
C.R.S. § 25.5-5-405 — CO Code / Title 25.5 / Article 5 / Part 4 / Section 25.5-5-405
25.5-5-405. Quality measurements
Status: repealed

25.5-5-405. Quality measurements. (Repealed)
C.R.S. § 25.5-3-107 — CO Code / Title 25.5 / Article 3 / Part 1 / Section 25.5-3-107
25.5-3-107. Report concerning the program
Status: in_force

25.5-3-107. Report concerning the program. Notwithstanding the provisions of section 24-1-136 (11)(a)(I), the executive director shall prepare an annual report concerning the status of the medically indigent program to be submitted to the health and human services committees of the senate and the house of representatives, or any successor committees, no later than February 1 of each year. The report shall be prepared following consultation with providers in the program, state department personnel, and other agencies, organizations, or individuals as the executive director deems appropriate in order to obtain comprehensive and objective information about the program.
C.R.S. § 25.5-5-327 — CO Code / Title 25.5 / Article 5 / Part 3 / Section 25.5-5-327
25.5-5-327. Eligible peer support services - reimbursement - definitions
Status: in_force

25.5-5-327. Eligible peer support services - reimbursement - definitions. (1) As used in this section, unless the context otherwise requires:

(a) "Peer support professional" has the same meaning as defined in section 27-60-108 (2)(b).

(b) "Recovery support services organization" has the same meaning as defined in section 27-60-108 (2)(c).

(2) Subject to available appropriations and to the extent permitted under federal law, the medical assistance program pursuant to this article 5 and articles 4 and 6 of this title 25.5 includes peer support professional services provided to members through a recovery support services organization. Peer support professional services must not be provided to members until federal approval has been obtained.
C.R.S. § 25.5-2.5-205 — CO Code / Title 25.5 / Article 2.5 / Part 2 / Section 25.5-2.5-205
25.5-2.5-205. Federal approval
Status: in_force

25.5-2.5-205. Federal approval. (1) On or before September 1, 2020, the state department shall submit a request to the United States secretary of health and human services for approval of the program under 21 U.S.C. sec. 384. The state department shall begin operating the program not later than six months after receiving such approval. The request must, at a minimum:

(a) Describe the state department's plan for operating the program;

(b) Demonstrate how the prescription drugs imported into the state under the program will meet the applicable federal and state standards for safety, effectiveness, misbranding, and adulteration;

(c) Include a list of prescription drugs that have the highest potential for cost savings to the state through importation at the time that the request is submitted;

(d) Estimate the total cost savings attributable to the program; and

(e) Include a list of potential Canadian suppliers from which the state would import prescription drugs and demonstrate that the suppliers are in full compliance with relevant Canadian federal and provincial laws and regulations.

(2) Notwithstanding any provision of this part 2 to the contrary, the state department may expend money for the purpose of requesting approval of the program as described in subsection (1) of this section but the state department shall not spend any other money to implement the program until the state department receives approval of the program as described in said subsection (1).

(3) Upon receipt of federal approval of the program, the state department shall notify the president of the senate and the speaker of the house of representatives, as well as the health and human services committee of the senate and the health and insurance committee of the house of representatives, or any successor committees. After approval is received and before the start of the next regular session of the general assembly in which the proposal could be funded, the state department shall submit to all parties specified in this subsection (3) a proposal for program implementation and program funding.
C.R.S. § 25.5-10-234 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-234
25.5-10-234. Confidentiality of sterilization proceedings
Status: in_force

25.5-10-234. Confidentiality of sterilization proceedings. All records, hearings, and proceedings pursuant to sections 25.5-10-231 to 25.5-10-233 are strictly confidential unless requested to be open to the public by the person with an intellectual and developmental disability or the person's legal guardian.
C.R.S. § 25.5-5-105 — CO Code / Title 25.5 / Article 5 / Part 1 / Section 25.5-5-105
25.5-5-105. Qualified disabled and working individuals
Status: in_force

25.5-5-105. Qualified disabled and working individuals. Qualified disabled and working individuals are persons with income and resources and disability status, as determined by the social security administration, which qualify them as "qualified disabled and working individuals" under sections 6012 and 6408 of the federal "Omnibus Budget Reconciliation Act of 1989", or subsequent amending federal legislation. The state department is hereby designated as the single state agency to administer benefits available to qualified disabled and working individuals. Such benefits are limited to medicare cost-sharing expenses as determined by the federal government. Accordingly, the state department shall not be required to provide qualified disabled and working individuals the entire range of services set forth in section 25.5-5-102.
C.R.S. § 25.5-3-112 — CO Code / Title 25.5 / Article 3 / Part 1 / Section 25.5-3-112
25.5-3-112. Health care services fund - creation - state plan amendment - primary care speci
Status: repealed

25.5-3-112. Health care services fund - creation - state plan amendment - primary care special distribution fund. (1) (a) There is hereby created in the state treasury the Colorado health care services fund, referred to in this section as the "fund". The fund shall consist of moneys credited thereto pursuant to this section.

(b) In fiscal year 2005-06, the general assembly shall appropriate fourteen million nine hundred sixty-two thousand four hundred eight dollars from the general fund to the fund. Of the moneys in the general fund exempt account created in section 24-77-103.6 (2), C.R.S., the following amounts shall be appropriated by the general assembly to the fund:

(I) In fiscal year 2007-08, fifteen million dollars; and

(II) In fiscal year 2008-09, twelve million nine hundred eighteen thousand seven hundred fifty dollars.

(III) (Deleted by amendment, L. 2010, (HB 10-1321), ch. 48, p. 179, § 1, effective March 29, 2010.)

(b.5) In fiscal year 2009-10, the general assembly shall appropriate ten million three hundred ninety thousand dollars from the general fund to the fund.

(b.6) In fiscal year 2011-12, the treasurer shall transfer one million dollars from the general fund to the fund.

(c) All moneys appropriated to the fund shall be used as provided in this section and shall not be deposited in or transferred to the general fund of this state or to any other fund. Notwithstanding any provision of section 24-36-114, C.R.S., to the contrary, all interest derived from the deposit and investment of moneys in the fund shall be credited to the fund.

(1.5) Notwithstanding any provision of subsection (1) of this section to the contrary, on April 20, 2009, the state treasurer shall deduct five hundred thousand dollars from the fund and transfer such sum to the general fund.

(2) In fiscal year 2006-07, and each of the two fiscal years thereafter, notwithstanding the requirements of section 25.5-3-108 (8)(b), the moneys deposited into the fund shall be appropriated as follows:

(a) Of the moneys appropriated pursuant to this subsection (2), eighteen percent of the moneys annually appropriated shall be to Denver health and hospitals as the community health clinic provider for the city and county of Denver.

(b) (I) For fiscal year 2006-07, eighty-two percent of the moneys remaining after the appropriation pursuant to paragraph (a) of this subsection (2) shall be appropriated to community health clinics to provide primary care services pursuant to this article.

(II) For fiscal year 2006-07, eighteen percent of the moneys remaining after the appropriation pursuant to paragraph (a) of this subsection (2) shall be appropriated to primary care clinics operated by a licensed or certified health-care facility to provide primary care services pursuant to this article.

(III) For fiscal years 2007-08 and 2008-09, the allocation of the moneys remaining after the appropriation pursuant to paragraph (a) of this subsection (2) shall be determined based on prior utilization as specified in rule by the state board.

(2.5) In fiscal year 2009-10, notwithstanding the requirements of section 25.5-3-108 (8)(b), the moneys deposited into the fund shall be appropriated as follows:

(a) Twenty percent of the moneys shall be appropriated to the state department for distribution to Denver health and hospitals as the community health clinic provider for the city and county of Denver;

(b) Eighty percent of the moneys shall be appropriated to the state department for distribution to community health clinics based upon prior utilizations as determined by the state department to mitigate reductions the clinics experience due to reductions in moneys available from the primary care fund created pursuant to section 24-22-117 (2)(b), C.R.S.

(2.7) In the 2010-11 fiscal year, notwithstanding the requirements of section 25.5-3-108 (8)(b), the moneys deposited into the fund shall be appropriated to the state department for distribution to Denver health and hospitals, as the community health clinic for the city and county of Denver, and to community health clinics. The state department shall develop a distribution formula specifying the distributions based upon prior utilizations and, to the extent possible, mitigation of the reductions in funding that the clinics experience due to reductions in moneys available from the primary care fund established pursuant to section 24-22-117 (2)(b), C.R.S.

(2.8) In the 2011-12 fiscal year, notwithstanding the requirements of section 25.5-3-108 (8)(b), the moneys deposited into the fund shall be appropriated to the state department for distribution to Denver health and hospitals, as the community health clinic for the city and county of Denver, to community health clinics, and to federally qualified health centers. The state department shall develop a distribution formula specifying the distributions based upon prior utilizations and, to the extent possible, mitigation of the reductions in funding that the clinics experience due to reductions in moneys available from the primary care fund established pursuant to section 24-22-117 (2)(b), C.R.S.

(3) (a) The state department shall submit a state plan amendment for federal financial participation for moneys appropriated to primary care clinics operated by a licensed or certified health-care facility. Upon approval of the state plan amendment, the state department is authorized to receive and expend all available federal moneys without a corresponding reduction in spending authority from the fund.

(b) To the extent possible under federal law, the state department shall pursue available federal financial participation for moneys appropriated to community health clinics.

(4) Repealed.
C.R.S. § 25.5-1-304 — CO Code / Title 25.5 / Article 1 / Part 3 / Section 25.5-1-304
25.5-1-304. Repeal of part
Status: in_force

25.5-1-304. Repeal of part. (Deleted by amendment)
C.R.S. § 25.5-6-406 — CO Code / Title 25.5 / Article 6 / Part 4 / Section 25.5-6-406
25.5-6-406. Appropriations - reimbursement for services - direct support professionals - leg
Status: repealed

25.5-6-406. Appropriations - reimbursement for services - direct support professionals - legislative declaration - definitions - repeal. (1) To carry out duties and obligations pursuant to this part 4 and for the administration and provision of services to eligible persons, all medicaid funds appropriated pursuant to Title XIX of the federal "Social Security Act", as amended, for the provision of care for persons with developmental disabilities and all other funds otherwise appropriated by the general assembly as additional sources of program funding are available for the placement of eligible persons either in intermediate care facilities for persons with intellectual disabilities or alternatives to such placements.

(2) (a) (I) The general assembly finds and declares that:

(A) Colorado's system of home- and community-based services that supports Coloradans with intellectual and developmental disabilities has grown to serve more than twelve thousand persons and their families;

(B) Costs associated with providing these services continue to rise with growth in demand, inflation, increased regulation, rising minimum wages, rising health-care costs, and other economic factors;

(C) Reimbursement rates have not kept pace with these rising costs, resulting in reduced access to services for Coloradans with intellectual and developmental disabilities;

(D) Colorado needs significant initial investments to address the most urgent issues concerning services for persons with intellectual and developmental disabilities, as well as future long-term planning to address the growing strain on the system;

(E) One of the most urgent issues is the workforce crisis among direct support professionals, characterized by chronically low wages, limited benefits, and lack of career advancement opportunities for these critical workers;

(F) Colorado is experiencing a workforce crisis among direct support professionals because reimbursement rates cannot support the compensation needed to match the high level of responsibility required in these jobs;

(G) Agencies that serve people with intellectual and developmental disabilities increasingly struggle to recruit and retain direct support professionals to meet the demand for services; and

(H) High turnover among direct support professionals results in reduced continuity of services for persons with intellectual and developmental disabilities.

(II) Therefore, as an initial investment, Colorado's reimbursement rates should be increased to allow for direct support professional compensation that better reflects market realities and the high level of responsibility required in these jobs.

(b) As used in this subsection (2), unless the context otherwise requires:

(I) "Compensation" means any form of monetary payment, including bonuses, employer-paid health and other insurance programs, paid time off, payroll taxes, and all other fixed and variable benefits conferred on or received by a direct support professional.

(II) "Direct support professional" means a worker who assists or supervises a worker to assist a person with intellectual and developmental disabilities to lead a fulfilling life in the community through a diverse range of services, including helping the person get ready in the morning, take medication, go to work or find work, and participate in social activities. "Direct support professional" includes all workers categorized as program direct support professionals and excludes workers categorized as administrative, as defined in standards established by the Financial Accounting Standards Board.

(c) The state department shall immediately seek a six and one-half percent increase in the reimbursement rate for the following services delivered through the home- and community-based services for persons with developmental disabilities, supported living services, and children's extensive supports waivers:

(I) Group residential services and supports;

(II) Individual residential services and supports;

(III) Specialized habilitation;

(IV) Respite;

(V) (A) Homemaker basic;

(B) This subsection (2)(c)(V) is repealed, effective July 1, 2025.

(VI) Homemaker enhanced;

(VII) (A) Personal care;

(B) This subsection (2)(c)(VII) is repealed, effective July 1, 2025.

(VIII) Prevocational services;

(IX) Behavioral line staff;

(X) Community connector;

(XI) Supported community connections;

(XII) Mentorship;

(XIII) Supported employment - job development; and

(XIV) Supported employment - job coaching.

(d) The state department shall implement a corresponding increase in service plan authorization limits to account for this increase in reimbursement rates.

(e) Service agencies shall use one hundred percent of the funding resulting from the increase in the reimbursement rate pursuant to subsection (2)(c) of this section to increase compensation for direct support professionals above the rate of compensation that direct support professionals are receiving as of June 30, 2018. This requirement applies to funds billed by case management agencies and entities in their role as organized health-care delivery systems, as defined in 42 CFR 447.10 (b). Service agencies shall not use funding resulting from the reimbursement rate increase for general and administrative expenses, such as chief executive officer salaries, human resources, information technology, oversight, business management, general record keeping, budgeting and finance, and other activities not identifiable to a single program.

(f) (I) For the 2018-19 through 2020-21 fiscal years, service agencies shall track how they used the funding resulting from the increase in the reimbursement rate pursuant to subsection (2)(c) of this section using a reporting tool developed by the state department in collaboration with service agencies. On or before December 31, 2019, service agencies shall submit the report to the state department demonstrating how the funding was used to increase direct support professional compensation for the 2018-19 fiscal year. The state department shall have ongoing discretion to request information from service agencies demonstrating how they maintained increases in compensation for direct support professionals beyond the three-year tracking period.

(II) Service agencies shall maintain all books, documents, papers, accounting records, and other evidence required to support the tracking of payroll information for increased compensation to direct support professionals pursuant to subsection (2)(f)(I) of this section for at least three years from the end of each respective fiscal year. Service agencies shall make the information and materials available for inspection by the state department or its designees at all reasonable times.

(g) If a service agency does not use one hundred percent of the funding resulting from the increase in the reimbursement rate pursuant to subsection (2)(c) of this section to increase compensation for direct support professionals, the state department may recoup part or all of the funding resulting from the increase in the reimbursement rate.

(h) If the state department determines that the service agency did not use the funding resulting from the increase in the reimbursement rate pursuant to subsection (2)(c) of this section as required, within one year after the end of each fiscal year described in subsection (2)(f)(I) of this section, the state department shall notify the service agency in writing of the state department's intention to recoup funds pursuant to subsection (2)(g) of this section.

(i) The service agency has forty-five days after receiving notice of the determination under subsection (2)(h) of this section to:

(I) Challenge the determination of the state department;

(II) Provide additional information to the state department demonstrating compliance; or

(III) Submit a plan of correction to the state department.

(j) The state department shall notify the service agency in writing of its final determination after affording the service agency the opportunity to take the actions specified in subsection (2)(i) of this section.

(k) The state department shall recoup from a service agency one hundred percent of the funding resulting from the increase in the reimbursement rate pursuant to subsection (2)(c) of this section that the service agency received but did not use for compensation for direct support professionals if:

(I) The service agency fails to respond to a notice of determination of the state department within the time provided in subsection (2)(i) of this section;

(II) The service agency is unable to provide documentation of compliance; or

(III) The state department does not accept the plan of correction submitted by the service agency pursuant to subsection (2)(i) of this section.

(l) The state department shall participate in the national core indicators staff stability survey.

(m) Once the state department determines that a sufficient quantity and quality of data exists to determine the impact and outcomes, if any, attributed to the increase in the reimbursement rate pursuant to subsection (2)(c) of this section on persons with intellectual and developmental disabilities, the state department shall include in its annual report concerning the waiting list for services and supports for persons with intellectual and developmental disabilities, required pursuant to section 25.5-10-207.5, information from the national core indicators data, or another comparable source, concerning in what ways outcomes for persons with intellectual and developmental disabilities changed as a result of the increase in reimbursement rates pursuant to subsection (2)(c) of this section. The report must include, if available, multiyear personal outcome data specific to Colorado and comparisons to other states, as appropriate, as well as data from the national core indicators staff stability survey.
C.R.S. § 25.5-2.5-104 — CO Code / Title 25.5 / Article 2.5 / Part 1 / Section 25.5-2.5-104
25.5-2.5-104. Program - rules - repeal
Status: repealed

25.5-2.5-104. Program - rules - repeal. (Repealed)
C.R.S. § 25.5-6-1806 — CO Code / Title 25.5 / Article 6 / Part 18 / Section 25.5-6-1806
25.5-6-1806. Repeal of part
Status: repealed

25.5-6-1806. Repeal of part. This part 18 is repealed, effective July 1, 2025.
C.R.S. § 25.5-5-506 — CO Code / Title 25.5 / Article 5 / Part 5 / Section 25.5-5-506
25.5-5-506. Prescribed drugs - utilization review
Status: repealed

25.5-5-506. Prescribed drugs - utilization review. (1) The state department shall develop and implement a drug utilization review process to assure the appropriate utilization of drugs by patients receiving medical assistance in the fee-for-service and primary care physician programs. The review process shall include the monitoring of prescription information and shall address at a minimum underutilization and overutilization of benefit drugs. Periodic reports of findings and recommendations shall be forwarded to the state department.

(2) It is the general assembly's intent that the implementation of a drug utilization review process for the fee-for-service and primary care physician programs will produce savings within the state's medicaid program. The state department, therefore, is authorized to use savings in the medical services premiums appropriations to fund the development and implementation of a drug utilization review process for these programs, as required by subsection (1) of this section. The state department may contract on a contingency basis for the development or implementation of the review process required by subsection (1) of this section.

(3) (a) The state department shall implement drug utilization mechanisms, including, but not limited to, prior authorization, to control costs in the medical assistance program associated with prescribed drugs. The state board shall promulgate a rule that outlines a process in which any interested party may be notified of and comment on the implementation of any prior authorization for a class of prescribed drugs before the class is prior authorized.

(b) Repealed.
C.R.S. § 25.5-5-418 — CO Code / Title 25.5 / Article 5 / Part 4 / Section 25.5-5-418
25.5-5-418. Primary care provider sustainability fund - creation - use of fund
Status: in_force

25.5-5-418. Primary care provider sustainability fund - creation - use of fund. The primary care provider sustainability fund is hereby created in the state treasury. The fund consists of money transferred to the fund from the children's basic health plan trust created in section 25.5-8-105 (1) pursuant to section 25.5-8-105 (8)(b) and any other money that the general assembly may appropriate or transfer to the fund. The state treasurer shall credit all interest and income derived from the deposit and investment of money in the fund to the fund. Any unexpended and unencumbered money in the fund at the end of any fiscal year remains in the fund and shall not be credited or transferred to the general fund or any other fund. Subject to annual appropriation by the general assembly, the state department may expend money from the fund for the purpose of increasing access to primary care through rate enhancements for primary care office visits, preventive medicine visits, counseling and health-risk assessments, immunization administration, health screening services, and newborn care, including neonatal critical care. Money expended from the fund for the purposes of increasing access to primary care through rate enhancements supplements and does not supplant general fund appropriations for that purpose.
C.R.S. § 25.5-6-902 — CO Code / Title 25.5 / Article 6 / Part 9 / Section 25.5-6-902
25.5-6-902. Children's personal assistance services and family support program
Status: repealed

25.5-6-902. Children's personal assistance services and family support program. (1) The general assembly finds that many families who attempt to care for severely disabled or terminally ill children at home often are burdened with the excessive financial and personal costs of providing continuous care. Private insurance companies rarely support essential, long-term custodial services and often establish monetary limits that are well below the levels required by these disabled children. When coverage is available, care is frequently provided in a medical model that is marginally appropriate to the needs of the children and the family and usually more expensive to the payer. The resulting pressures often contribute to family disintegration and increased dependency on public programs. The general assembly finds that it is in the best interests of the citizens of the state to encourage the preservation of families with children with disabilities.

(2) As used in this section, unless the context otherwise requires, "eligible disabled children" means children eighteen years of age or younger:

(a) Who have medical needs that, pursuant to state department rules, would qualify them for institutionalization or place them at risk of institutionalization in an acute care hospital or nursing facility;

(b) Who have gross incomes, including the amount of parental income and resources to be attributed to the child's gross income according to rules to be promulgated by the state board, that do not exceed three hundred percent of the current federal supplemental security income benefit level;

(c) Who are not receiving long-term services from any alternative waiver program established under this title;

(d) For whom a licensed physician or an advanced practice registered nurse has certified that in-home care is an appropriate way to meet the child's needs; and

(e) For whom the cost of care outside of the institution is no higher than the estimated medicaid cost of appropriate institutional care.

(3) There is hereby established in the state department the children's personal assistance services and family support waiver program, referred to in this section as the "program", to provide services to eligible disabled children in their homes rather than in the confines of an acute care hospital or nursing facility. The number of children enrolled in this program or any other model 200 program shall not exceed the state department's ability to cover the costs of the programs within the annual appropriations for this program and any other model 200 program.

(4) Priority for participation in the program shall be given first to children who are on the waiting list for other model 200 programs and secondly to children whose parents will return to work if appropriate care for their disabled child is provided under the program. Spaces in the program shall also be available to children who were already covered by medicaid but who were rendered temporarily ineligible for a period of not more than three months due to a periodic or cyclical peak in their parents' income.

(5) The state board shall adopt rules to govern the program consistent with any federal waivers including, but not limited to, rules concerning:

(a) Services that are reimbursable under this section including, but not limited to:

(I) Respite care, to the degree its additional cost is offset by collection of a parental copayment;

(II) Case management; and

(III) Medically necessary professional or community services beyond those specified in section 25.5-5-102 or 25.5-5-202, to the degree that they provide a cost-effective and medically appropriate alternative to covered services;

(b) Provider selection and certification;

(c) Documentation for assessment and recertification;

(d) Repealed.

(e) Reimbursement.

(6) The case management agency, in coordination with the eligible disabled child's family and the child's physician, shall include in each case plan a process by which the eligible disabled child may receive necessary care, which may include respite care, if the eligible disabled child's family or care provider is unavailable due to an emergency situation or to unforeseen circumstances. The eligible disabled child's family shall be duly informed by the case management agency of these alternative care provisions at the time the case plan is initiated.

(7) If the state department finds it cost-effective and all necessary federal waivers are obtained, parents of eligible disabled children may be authorized to hire and manage care providers from certified medicaid agencies. Case management agencies shall work with parents to develop the skills necessary for ongoing care management.

(8) The state department is authorized to seek waivers from the federal government to qualify for federal financial participation in the program.

(9) The state department is authorized to charge and collect copayments from parents for services rendered.

(10) The state department is directed to study the advisability of setting an upper limit on parental income for participation in this program and other children's medicaid waiver programs.
C.R.S. § 25.5-10-214 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-214
25.5-10-214. Community residential home - licenses - rules
Status: in_force

25.5-10-214. Community residential home - licenses - rules. (1) The department of public health and environment and the state department shall implement a system of joint licensure and certification of community residential homes. Independent residential support services provided by the state department do not require licensure by the department of public health and environment.

(2) (a) The department of public health and environment and the state department shall develop standards for the licensure and certification of community residential homes. The standards shall include health, life, and fire safety, as well as standards to ensure the effective delivery of services and supports to residents; except that any community residential home must comply with local codes.

(b) (I) The state department or the state board of health, as appropriate, shall adopt the standards by rule and shall specify the responsibilities of each department in the program. Surveys undertaken to ensure compliance with these standards shall, as appropriate, be undertaken as joint surveys by the departments.

(II) If a service agency operates a community residential home and provides personal care services, as defined in section 25-27.5-102, C.R.S., the department of public health and environment or the state department, as appropriate, is responsible for surveying those services provided by the service agency, which survey shall be conducted simultaneously with the survey of the community residential home.

(3) Any community residential home applying for a license or certification on or after January 1, 1986, shall accommodate at least four but no more than eight persons with intellectual and developmental disabilities. All licenses and certificates issued by the department of public health and environment or the state department shall bear the date of issuance and shall be valid for not more than a twenty-four-month period.

(4) The issuance, suspension, revocation, modification, renewal, or denial of a license or certification shall be governed by the provisions of section 24-4-104, C.R.S. The failure of a community residential home to comply with the provisions of this article and the rules promulgated thereunder, or any local fire, safety, and health codes shall be sufficient grounds for the department of public health and environment or the state department to deny, suspend, revoke, or modify the community residential home's license or certification.

(5) The state department and the state board of health shall promulgate such rules as are necessary to implement this section, pursuant to the provisions specified in article 4 of title 24, C.R.S. The rules shall include, but shall not be limited to, the following:

(a) Requirements concerning the distance between the location of community residential homes and factors to be considered in waiving such requirements for existing community residential homes;

(b) Procedures to secure the health and safety of persons receiving services or supports residing in a community residential home in the event the community residential home closes or its license is denied, suspended, or revoked pursuant to this section; and

(c) Prohibiting the cultivation, use, or consumption of retail marijuana on the premises of a community residential home.
C.R.S. § 25.5-5-207 — CO Code / Title 25.5 / Article 5 / Part 2 / Section 25.5-5-207
25.5-5-207. Adult dental benefit - adult dental fund - creation - legislative declaration
Status: repealed

25.5-5-207. Adult dental benefit - adult dental fund - creation - legislative declaration. (1) (a) The general assembly finds that:

(I) As of 2011, Colorado was one of only ten states that did not offer basic oral health services to adults under medicaid;

(II) Research has shown that untreated oral health conditions negatively affect a person's overall health and that gum disease has been linked to diabetes, heart disease, strokes, kidney disease, dementia diseases and related disabilities, and even behavioral or mental health disorders;

(III) Regular dental care and prevention are the most cost-effective methods available to prevent minor oral conditions from developing into more complex oral and physical health conditions that would eventually require emergency and palliative care;

(IV) Further, one in four adults has untreated tooth decay. Early detection and access to preventive and restorative treatments for oral health conditions can be up to ten times less expensive than treating those same conditions in an emergency setting.

(V) Research has also shown that good oral health improves medicaid beneficiaries' ability to obtain and keep employment. Employed adults lose more than one hundred and sixty-four million hours of work each year due to dental problems.

(VI) Children are more likely to receive regular dental services if their parents have access to dental services; and

(VII) Pregnant women are one of the most vulnerable adult populations that are without oral health benefits under medicaid. During pregnancy, the physical changes a woman's body undergoes can negatively affect oral health. Untreated decay and periodontal disease are associated with adverse pregnancy outcomes such as increased risk for preeclampsia, pre-term labor, and low birth weight babies.

(b) Therefore, the general assembly declares that in order to improve overall health, promote savings in medicaid programs, and prevent future health conditions caused by oral health problems, it is in the best interest of the state of Colorado to create a limited oral health benefit for adults in the medicaid program.

(2) (a) Pursuant to section 25.5-5-202 (1)(w), by April 1, 2014, the state department shall design and implement a limited dental benefit for adults using a collaborative stakeholder process to consider the components of the benefit, including but not limited to the cost, best practices, the effect on health outcomes, member experience, service delivery models, and maximum efficiencies in the administration of the benefit.

(b) The state department shall determine the most cost-effective method for providing the adult dental benefit, including but not limited to a comparison of a capitated or fee-for-service method of payment and the purchase of dental insurance.

(c) The state department shall seek any federal authorization necessary to provide the adult dental benefit.

(d) Subject to federal authorization and federal financial participation, on or after July 1, 2016, the diagnosis, development of a treatment plan, instruction to perform an interim therapeutic restoration procedure, or supervision of a dental hygienist performing an interim therapeutic restoration procedure may be provided through telehealth, including store-and-forward transfer, in accordance with section 25.5-5-321.5.

(2.5) Repealed.

(3) If the state department chooses to use an administrative service organization to manage the adult dental benefit:

(a) The contract with the administrative service organization must provide that the contracting entity is prohibited from requiring dental providers to participate in any other public or private program or to accept any other insurance products as a condition of participating as a dental provider; and

(b) The state department shall retain policy-making authority, including but not limited to policies concerning covered benefits and rate setting.

(4) (a) There is hereby created in the state treasury the adult dental fund, referred to in this section as the "fund", consisting of money transferred to the fund from the unclaimed property trust fund pursuant to section 38-13-801 (3) and any money that may be appropriated to the fund by the general assembly. The money in the fund is subject to annual appropriation by the general assembly to the state department for the direct and indirect costs associated with implementing the adult dental benefit pursuant to section 25.5-5-202 (1)(w).

(b) The state treasurer may invest any unexpended moneys in the fund as provided by law. The state treasurer shall credit all interest and income derived from the investment and deposit of moneys in the fund to the fund.

(c) Any unexpended and unencumbered moneys remaining in the fund at the end of a fiscal year remain in the fund and shall not be credited or transferred to the general fund or another fund.
C.R.S. § 25.5-5-421 — CO Code / Title 25.5 / Article 5 / Part 4 / Section 25.5-5-421
25.5-5-421. Parity reporting - state department - public input
Status: in_force

25.5-5-421. Parity reporting - state department - public input. (1) The state department shall require each MCE contracted with the state department to disclose all necessary information in order for the state department, by June 1, 2020, and by each June 1 thereafter, to submit a report to the health and insurance committee and the public health care and human services committee of the house of representatives, or their successor committees, and to the health and human services committee of the senate, or its successor committee, regarding behavioral, mental health, and substance use disorder parity. The report must contain the following information for the prior calendar year:

(a) A description of the process used to develop or select the medical necessity criteria for behavioral, mental health, and substance use disorder benefits and the process used to develop or select the medical necessity criteria for medical and surgical benefits;

(b) Identification of all nonquantitative treatment limitations that are applied to behavioral, mental health, and substance use disorder benefits and to medical and surgical benefits within each classification of benefits and a statement that the state is complying with 42 U.S.C. sec. 300gg-26 (a)(3)(A)(ii), as required by 42 U.S.C. sec. 1396u-2 (b)(8), prohibiting the application of nonquantitative treatment limitations to behavioral, mental health, and substance use disorder benefits that do not apply to medical and surgical benefits within any classification of benefits;

(c) (I) The results of analyses demonstrating that, for the medical necessity criteria described in subsection (1)(a) of this section and each nonquantitative treatment limitation identified in subsection (1)(b) of this section, as written and in operation, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each nonquantitative treatment limitation to benefits for behavioral, mental health, and substance use disorders within each classification of benefits are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each nonquantitative treatment limitation to medical and surgical benefits within the corresponding classification of benefits.

(II) A report on the results of the analyses specified in this subsection (1)(c) must, at a minimum:

(A) Identify the factors used to determine that a nonquantitative treatment limitation will apply to a benefit, including factors that were considered but rejected;

(B) Identify and define the specific evidentiary standards used to define the factors and any other evidence relied on in designing each nonquantitative treatment limitation;

(C) Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to design each nonquantitative treatment limitation, as written, and the written processes and strategies used to apply each nonquantitative treatment limitation for benefits for behavioral, mental health, and substance use disorders are comparable to, and are applied no more stringently than, the processes and strategies used to design and apply each nonquantitative treatment limitation, as written, and the written processes and strategies used to apply each nonquantitative treatment limitation for medical and surgical benefits;

(D) Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to apply each nonquantitative treatment limitation, in operation, for benefits for behavioral, mental health, and substance use disorders are comparable to, and are applied no more stringently than, the processes and strategies used to apply each nonquantitative treatment limitation, in operation, for medical and surgical benefits; and

(E) Disclose the specific findings and conclusions that indicate that the state is in compliance with this section and with the MHPAEA.

(2) By October 1, 2019, for purposes of obtaining meaningful public input during the assessment process described in subsection (1) of this section, the state department shall seek input from stakeholders who may have competency in benefit and delivery systems, utilization management, managed care contracting, data and reporting, or compliance and audits. The state department shall consider the input received in conducting the analyses and developing the report pursuant to subsection (1) of this section.

(3) Notwithstanding section 24-1-136 (11)(a)(I), the reporting requirement specified in this section continues indefinitely.

(4) The state department shall contract with an external quality review organization at least annually to monitor MCEs' utilization management programs and policies, including those that govern adverse determinations, to ensure compliance with the MHPAEA. The quality review report must be readily available to the public.
C.R.S. § 25.5-1-128 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-128
25.5-1-128. Provider payments - compliance with state fiscal requirements - rules - definiti
Status: repealed

25.5-1-128. Provider payments - compliance with state fiscal requirements - rules - definitions - repeal. (1) (a) Notwithstanding any provision of law to the contrary, when the state department has regulatory authority over a program and when the provider has already signed a state department-approved provider application to provide a service or to bill the state department or its authorized contractor for a service, the state department-approved provider application shall serve to fulfill the requirements of a commitment voucher and the fiscal requirements of section 24-30-202 (1), C.R.S.

(b) [Editor's note: This version of the introductory portion to subsection (1)(b) is effective until July 1, 2025.] The executive director may promulgate rules to exempt a provider who provides services through a program as described in paragraph (a) of this subsection (1) for any program the state department is authorized by law to administer, including but not limited to:

(b) [Editor's note: This version of the introductory portion to subsection (1)(b) is effective July 1, 2025.] The executive director may promulgate rules to exempt a provider who provides services through a program as described in subsection (1)(a) of this section for any program the state department is authorized by law to administer, including but not limited to:

(I) The "Colorado Medical Assistance Act", articles 4 to 6 of this title;

(II) The "Children's Basic Health Plan Act", article 8 of this title;

(III) (A) The "Colorado Indigent Care Program", part 1 of article 3 of this title;

(B) This subsection (1)(b)(III) is repealed, effective July 1, 2025.

(IV) The school health services program authorized by section 25.5-5-318;

(V) Programs that are funded through the primary care fund, created in section 24-22-117 (2)(b), C.R.S.; and

(VI) The state-funded old age pension health and medical care program pursuant to article 2 of this title.

(1.5) The state department shall maintain a list of enrolled school-based health centers and school-linked health-care services providers. The state department shall develop the list based on grant enrollment data pursuant to section 25-20.5-503 that is provided to the state department by the department of public health and environment. The state department shall establish a process for identifying claims for services provided in these settings.

(2) [Editor's note: This version of subsection (2) is effective until July 1, 2025.] As used in this section, unless the context otherwise requires, "provider" means a health-care provider, a mental health-care provider, a pharmacist, a home health agency, a general provider as defined in section 25.5-3-103 (3), a school district as defined in section 25.5-5-318 (1)(a), or any other entity that provides health care, health-care coordination, outreach, enrollment, or administrative support services to members through fee-for-service, a managed care entity, a behavioral health organization, a medical home, or any system of care that coordinates health care or services as defined and authorized through rules promulgated by the state board or by the executive director.

(2) [Editor's note: This version of subsection (2) is effective July 1, 2025.] As used in this section, unless the context otherwise requires, "provider" means a health-care provider; a mental health-care provider; a pharmacist; a home health agency; a general hospital, birth center, or community clinic licensed or certified by the department of public health and environment pursuant to section 25-1.5-103 (1)(a)(I) or (1)(a)(II); a federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec 1395x (aa)(4); a rural health clinic, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2); a health maintenance organization issued a certificate of authority pursuant to section 10-16-402; a school district as defined in section 25.5-5-318 (1)(a); or any other entity that provides health care, health-care coordination, outreach, enrollment, or administrative support services to members through fee-for-service, a managed care entity, a behavioral health organization, a medical home, or any system of care that coordinates health care or services as defined and authorized through rules promulgated by the state board or by the executive director.
C.R.S. § 25.5-6-302 — CO Code / Title 25.5 / Article 6 / Part 3 / Section 25.5-6-302
25.5-6-302. Legislative declaration
Status: in_force

25.5-6-302. Legislative declaration. The general assembly hereby finds and declares that it is the purpose of this part 3 to provide, under a federal waiver of statutory requirements, for an array of home- and community-based services to eligible elderly, blind, and disabled individuals as an alternative to nursing facility placement.
C.R.S. § 25.5-4-405 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-405
25.5-4-405. Mental health managed care service providers - requirements
Status: in_force

25.5-4-405. Mental health managed care service providers - requirements. (1) Each contract between the state department and a managed care organization providing mental health services to a member under the medical assistance program must comply with all federal requirements, including but not limited to:

(a) Ensuring that a member with complex or multiple needs who requires mental health services has access to mental health professionals with appropriate training and credentials and providing the member with the services in collaboration with the member's other providers;

(b) Informing each member of the member's right to and the process for appeal upon notification of denial, termination, or reduction of a requested service; and

(c) Administering initial stabilization treatment for a member and transferring the member for appropriate continued services.

(1.5) Each contract between the state department and a managed care organization providing mental health services to a member under the medical assistance program must allow for the use of telemedicine pursuant to section 25.5-5-320.

(2) For mental health managed care members, the state department shall have a patient representative program for member grievances that complies with all federal requirements and that must:

(a) Be posted in a conspicuous place at each location at which mental health services are provided;

(b) Allow for a patient representative to serve as a liaison between the member and the provider;

(c) Describe the qualifications for a patient representative;

(d) Outline the responsibilities of a patient representative;

(e) Describe the authority of a patient representative; and

(f) Establish a method by which each member is informed of the patient representative program and how a patient representative may be contacted.
C.R.S. § 25.5-1-110 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-110
25.5-1-110. Study of children's access to health care coverage - acceptance of donations - r
Status: repealed

25.5-1-110. Study of children's access to health care coverage - acceptance of donations - repeal. (Repealed)
C.R.S. § 25.5-1-206 — CO Code / Title 25.5 / Article 1 / Part 2 / Section 25.5-1-206
25.5-1-206. School-based substance abuse prevention and intervention program - creation - re
Status: repealed

25.5-1-206. School-based substance abuse prevention and intervention program - creation - reporting - legislative declaration - definitions. (1) (a) The general assembly finds and declares that:

(I) The 2011 healthy kids Colorado survey indicates that the top three substances that high school students report they use are alcohol, marijuana, and prescription drugs;

(II) With the legalization of marijuana by citizen initiative in Colorado, there is an increased availability of marijuana in the community and, at the same time, a decreased perception of harm related to marijuana use;

(III) Evidence-based prevention and intervention programs and education awareness programs targeted to school children who are twelve to nineteen years of age are needed to:

(A) Increase the perceived risk of harm associated with marijuana and alcohol use and prescription drug misuse;

(B) Decrease the rates of youth marijuana and alcohol use and prescription drug misuse and delay the age of first-time use; and

(C) Decrease the number of drug- and alcohol-related violations, suspensions, and expulsions reported by schools.

(b) Therefore, the general assembly declares that it is appropriate to award grants to schools, community-based organizations, and health organizations to provide school-based prevention and intervention programs that use evidence-based strategies, practices, and approaches to reduce the risk of marijuana and alcohol use and prescription drug misuse by school-aged children. Successful school-based programs will lead to increased overall health, behavioral health, and educational outcomes for Colorado's youth.

(2) As used in this section, unless the context otherwise requires:

(a) "Entity" means a school, school district, board of cooperative services, a nonprofit or not-for-profit community-based organization, or a community-based behavioral health organization.

(b) "Grant program" means the school-based substance abuse prevention and intervention grant program created in subsection (3) of this section.

(3) (a) The school-based substance abuse prevention and intervention grant program is created within the state department. The purpose of the grant program is to award competitive grants to entities to provide school-based prevention and intervention programs for youth twelve to nineteen years of age primarily focused on reducing marijuana use, but including strategies and efforts to reduce alcohol use and prescription drug misuse.

(b) To be considered for a competitive grant, the entity must demonstrate in the grant proposal that:

(I) The grant will be used to implement evidence-based programs and strategies delivered in the school setting that are designed to improve overall health, behavioral health, and educational outcomes for youth who are twelve to nineteen years of age;

(II) The entity is delivering the program and strategies to at-risk youth, regardless of the youths' eligibility for Colorado's medical assistance program; and

(III) The evidence-based programs and strategies are designed to achieve the following outcomes:

(A) An increase in the perceived risk of harm associated with marijuana use, prescription drug misuse, and underage alcohol use among youth who are twelve to nineteen years of age;

(B) A decrease in the rates of youth marijuana use, alcohol use, and prescription drug misuse;

(C) A delay in the age of first use of marijuana, alcohol, or prescription drug misuse;

(D) A decrease in the rates of youth who have ever used marijuana or alcohol or misused prescription drugs in their lifetime; and

(E) A decrease in the number of drug- and alcohol-related violations on school property, suspensions, and expulsions reported by schools.

(4) On or before September 1, 2014, the state department shall establish procedures and timelines for grant applications, criteria for determining grant amounts and grantee reporting requirements, and any other grant program policies. The state department may amend these policies at any time.

(5) Subject to available appropriations, the state department shall award grants for the 2014-15 academic year and for each academic year thereafter. There is no limit on the number of grants that the state department may award, and the same entity may receive more than one grant if the state department considers the needs of at-risk students in communities throughout the state for school-based substance abuse prevention and intervention programs.

(6) Repealed.
C.R.S. § 25.5-5-204.5 — CO Code / Title 25.5 / Article 5 / Part 2 / Section 25.5-5-204.5
25.5-5-204.5. Continuous eligibility - children
Status: repealed

25.5-5-204.5. Continuous eligibility - children. (1) A child who is determined to be eligible for benefits under this article or under article 4 or 6 of this title shall remain eligible for twelve months subsequent to the last day of the month in which the child was enrolled; except that a child shall no longer be eligible and shall be disenrolled from the state medical assistance program if the state department becomes aware of or is notified that the child has moved out of the state or has reached nineteen years of age.

(2) Notwithstanding the provisions of subsection (1) of this section, if the money in the healthcare affordability and sustainability fee cash fund established pursuant to section 25.5-4-402.4, together with the corresponding federal matching funds, is insufficient to fully fund all of the purposes described in section 25.5-4-402.4 (5)(b), after receiving recommendations from the Colorado healthcare affordability and sustainability enterprise established pursuant to section 25.5-4-402.4 (3), the state board by rule adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III) may eliminate the continuous enrollment requirement pursuant to this section.

(3) Repealed.
C.R.S. § 25.5-1-207 — CO Code / Title 25.5 / Article 1 / Part 2 / Section 25.5-1-207
25.5-1-207. Rural provider access and affordability stimulus grant program - advisory commit
Status: repealed

25.5-1-207. Rural provider access and affordability stimulus grant program - advisory committee - fund - reporting - rules - definitions - repeal. (1) Definitions - rules. As used in this section:

(a) "Advisory committee" means the rural provider access and affordability advisory committee created in subsection (3)(a) of this section.

(b) "Affiliate" has the meaning set forth in section 25.5-4-402.8 (1)(b).

(c) "Frontier provider" means a provider that is located in a county in the state with a population density of six or fewer residents per one square mile.

(d) "Fund" means the rural provider access and affordability fund created in subsection (6)(a) of this section.

(e) "Grant program" means the rural provider access and affordability stimulus grant program established in subsection (2) of this section.

(f) "Health-care access projects" means the projects described in subsection (2)(c)(II) of this section.

(g) "Health-care affordability projects" means the projects described in subsection (2)(c)(I) of this section.

(h) "Hospital" means a hospital licensed or certified pursuant to section 25-1.5-103 (1)(a) or an affiliate owned or controlled, as defined in section 25.5-4-402.8 (1)(c), by the hospital.

(i) "Qualified rural provider" means a rural hospital that has a lower net patient revenue or fund balance compared with other rural hospitals, as determined by the state board by rule.

(j) "Rural community" means:

(I) A county with a population of fewer than fifty thousand residents; or

(II) A municipality with a population of fewer than twenty-five thousand residents if the municipality is not contiguous to a municipality with a population of twenty-five thousand or more residents.

(k) "Rural provider" means a hospital that is located in a rural community.

(l) "Telemedicine" has the meaning set forth in section 12-240-104 (6).

(2) Grant program - permissible uses of grant money. (a) The rural provider access and affordability stimulus grant program is hereby created in the state department. The purpose of the grant program is to provide state assistance in the form of grants to qualified rural providers based on financial need or the ability to expand health-care access. The grant program is intended to improve health-care affordability and access in rural communities.

(b) In consultation with the advisory committee, the state department shall administer the grant program and shall award grants to qualified rural providers in accordance with this section. The grants are paid out of money in the fund.

(c) Subject to the guidelines adopted pursuant to subsection (4) of this section and the rules promulgated by the state board pursuant to subsection (5)(b) of this section, qualified rural providers may use the money received through the grant program for:

(I) Projects that modernize the information technology infrastructure of rural providers, including projects that:

(A) Create a shared analytics platform and care coordination platforms among rural providers; and

(B) Enable technologies, including telehealth and e-consult systems, that allow rural providers to communicate, share clinical information, and consult electronically to manage patient care; and

(II) Projects that expand access to health care in rural communities, including projects that:

(A) Extend hours for access to health care in rural communities, including access to primary care and behavioral health services;

(B) Invest in dual track emergency department management in rural communities;

(C) Expand access to telemedicine in rural communities, including remote monitoring support;

(D) Provide new or replacement hospital beds in rural communities;

(E) Expand access to remote patient monitoring systems in rural communities;

(F) Expand access in rural communities to long-term care and recovery care in skilled nursing facilities; and

(G) Create or expand sites that provide access in rural communities to surgical care; chemotherapy centers; imaging and advanced imaging, including magnetic resonance imaging and computerized tomography scans; and behavioral health care.

(d) To be eligible to receive grant money that originates from the money the state received from the coronavirus state fiscal recovery fund for a capital expenditure, a grant recipient must submit to the state department a written justification as set forth in 31 CFR 35.6 (b)(4) for the capital expenditure; except that this requirement does not apply if the state department determines that the written justification is not required based on how the expenditures authorized under this section will be reported to the United States department of the treasury. For grant money that does not originate from the money the state received from the coronavirus state fiscal recovery fund, a written justification is not required, except as the state department determines necessary to comply with federal written justification requirements.

(3) Advisory committee. (a) The rural provider access and affordability advisory committee is hereby created in the state department.

(b) The advisory committee consists of the following voting members, appointed by the executive director:

(I) One member representing the state department;

(II) One member representing the department of public health and environment;

(III) One member representing the office of ehealth innovation in the lieutenant governor's office;

(IV) One member representing a nonprofit organization with expertise in health care in rural communities;

(V) Four members representing rural providers, including at least two frontier providers; and

(VI) One health-care consumer located in a rural community who is a member of the disabled community.

(c) The executive director shall make all appointments to the advisory committee no later than August 1, 2022. Advisory committee members serve for the duration of the advisory committee. The executive director shall fill any vacancy by appointment.

(d) The executive director shall convene the first meeting of the advisory committee no later than September 1, 2022. At the first meeting, the advisory committee shall select a chair and vice-chair from among its members. The advisory committee shall conduct at least two meetings each year and may agree to conduct meetings more frequently.

(e) The advisory committee shall advise and make formal recommendations to:

(I) The state department on:

(A) The administration of the grant program;

(B) The guidelines adopted pursuant to subsection (4) of this section; and

(C) The selection of grant recipients; and

(II) The state board on the rules promulgated pursuant to subsection (5) of this section.

(4) Guidelines. (a) On or before December 31, 2022, the state department, in consultation with the advisory committee, shall adopt guidelines for the grant program that include:

(I) Procedures and timelines by which a qualified rural provider may apply for a grant;

(II) Criteria for determining grant eligibility and grant amounts; and

(III) Reporting requirements for grant recipients in accordance with subsection (8)(b) of this section and the rules promulgated by the state board pursuant to subsection (5)(c) of this section.

(b) The state department shall post the guidelines on the state department's website.

(5) Rules. On or before December 31, 2022, the state board, in consultation with the state department, shall promulgate rules as necessary for the administration of this section that include:

(a) A methodology to determine which rural providers are considered qualified rural providers;

(b) Permissible uses of grant money; and

(c) Reporting requirements for grant recipients.

(6) Fund. (a) The rural provider access and affordability fund is hereby created in the state treasury. The fund consists of:

(I) Money transferred to the fund pursuant to subsection (7) of this section;

(II) Money appropriated or transferred to the fund by the general assembly; and

(III) Any gifts, grants, or donations from any public or private sources, including governmental entities.

(b) The state department is authorized to seek, accept, and expend gifts, grants, or donations from public or private sources for the purposes of the grant program. The state department shall transmit all public or private money received through gifts, grants, and donations to the state treasurer, who shall credit the same to the fund.

(c) Except as otherwise required by this subsection (6)(c), all money not expended or encumbered, and all interest earned on the investment or deposit of money in the fund, must remain in the fund and shall not revert to the general fund or any other fund at the end of any fiscal year. The money in the fund is continuously appropriated to the state department for the purposes of this section. Any money in the fund not expended or encumbered by December 31, 2024, reverts to the general fund.

(7) Transfer. No later than July 1, 2022, the state treasurer shall transfer ten million dollars from the economic recovery and relief cash fund created in section 24-75-228 (2)(a) to the fund. The state department shall use:

(a) Four million eight hundred thousand dollars for awarding grants for health-care affordability projects;

(b) Four million eight hundred thousand dollars for awarding grants for health-care access projects; and

(c) Up to four hundred thousand dollars for the costs of administering the grant program.

(8) Reporting. (a) In its presentation to the joint committees of reference pursuant to section 2-7-203, the state department shall report on the progress of the grant program, including a report on the amount of grant money awarded to each grant recipient and a description of each grant recipient's use of the grant money.

(b) The state department and any person that receives money from the state department, including each grant recipient, shall comply with the compliance, reporting, record-keeping, and program evaluation requirements established by the office of state planning and budgeting and the state controller in accordance with section 24-75-226 (5).

(9) Repeal. This section is repealed, effective July 1, 2025.
C.R.S. § 25.5-6-604 — CO Code / Title 25.5 / Article 6 / Part 6 / Section 25.5-6-604
25.5-6-604. Cost of services
Status: in_force

25.5-6-604. Cost of services. Home- and community-based services for persons with major mental health disorders must meet aggregate federal waiver budget neutrality requirements.
C.R.S. § 25.5-1-104 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-104
25.5-1-104. Department of health care policy and financing created - executive director - po
Status: in_force

25.5-1-104. Department of health care policy and financing created - executive director - powers, duties, and functions - report. (1) There is hereby created the department of health care policy and financing, the head of which shall be the executive director of the department of health care policy and financing, which office is hereby created. The executive director shall be appointed by the governor, with the consent of the senate, and shall serve at the pleasure of the governor. The reappointment of an executive director after an initial election of a governor shall be subject to the provisions of section 24-20-109, C.R.S. The executive director has those powers, duties, and functions prescribed for the heads of principal departments in the "Administrative Organization Act of 1968", article 1 of title 24, C.R.S., and any powers, duties, and functions set forth in this title.

(2) The department of health care policy and financing shall consist of an executive director of the department of health care policy and financing, the medical services board, and such divisions, sections, and other units as shall be established by the executive director pursuant to the provisions of subsection (3) of this section.

(3) The executive director may establish such divisions, sections, and other units within the state department as are necessary for the proper and efficient discharge of the powers, duties, and functions of the state department; except that such action by the executive director shall not conflict with the implementation requirements for the plan for restructuring the delivery of health and human services in this state, as set forth in article 1.7 of title 24, C.R.S.

(4) The department of health care policy and financing shall be responsible for the administration of the functions and programs as set forth in this title.

(5) (a) The executive director of the state department shall appoint an internal auditor who shall have the status of a division director and, as such, shall have the authority to appoint such personnel as may be necessary to carry out the duties of the internal auditor.

(b) The internal auditor appointed by the executive director pursuant to paragraph (a) of this subsection (5) shall:

(I) Conduct and supervise internal audits of the state department;

(II) Coordinate and facilitate external audits that are performed on the state department by state and federal entities;

(III) Conduct and supervise performance audits for the purpose of determining the efficiency and effectiveness of the state department's operation and administration of programs; and

(IV) Conduct such other audits and perform such other duties as may be specified by the executive director.

(6) (a) (I) The state department shall collaborate with the department of education, the department of public health and environment, and the department of human services to develop an interagency resource guide pursuant to section 22-2-410 to assist facilities to become licensed or authorized as approved facility schools and to recommend changes related to the interagency resource guide to the state department's statute, rule, or administrative procedures.

(II) The state department shall prominently post the interagency resource guide created pursuant to subsection (6)(a)(I) of this section on the state department's website.

(b) On or before November 1, 2023, the state department, after consulting with the facility school work group created in section 22-2-407.5, shall recommend a plan to provide guidance to approved facility schools on the eligibility standards required to request and receive medicaid reimbursement funding for therapeutic services to the maximum extent possible to reduce reliance on school district revenues for tuition payments required pursuant to section 22-20-109. The plan must include best practices from other states, recommendations on required federal or state authority changes, cost estimates, and cost-saving potentials.
C.R.S. § 25.5-10-221 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-221
25.5-10-221. Right to humane treatment
Status: in_force

25.5-10-221. Right to humane treatment. (1) Corporal punishment of persons with an intellectual and developmental disability is not permitted.

(2) All service agencies shall prohibit mistreatment, exploitation, neglect, or abuse in any form of any person receiving services.

(3) Service agencies shall provide every person receiving services with a humane physical environment.

(4) Each person receiving services must be attended to by qualified staff in numbers sufficient to provide appropriate services and supports.

(5) Seclusion, defined as the placement of a person receiving services alone in a closed room for the purpose of punishment, is prohibited.

(6) "Time out" procedures, defined as separation from other persons receiving services and group activities, may be employed under close and direct professional supervision, as defined by rule by the state board, and only as a technique in behavior-shaping programs. Behavior-shaping programs utilizing a "time out" procedure may be implemented only when it incorporates a positive approach designed to result in the acquisition of adaptive behaviors. Such behavior programs may only be implemented following the completion of a comprehensive functional analysis, when alternative nonrestrictive procedures have been proven to be ineffective, and only with the informed consent of the person, parents, or legal guardian. Such behavior programs may be implemented only following the review and approval process defined in rules. Behavior development programs must be developed in conjunction with the interdisciplinary team and implemented only following review by the human rights committee. Behavior development programs involving the use of the procedure in a "time out room" are prohibited.

(7) Behavior development programs involving the use of aversive or noxious stimuli are prohibited.

(8) Physical restraint, defined as the use of manual methods intended to restrict the movement or normal functioning of a portion of a person's body through direct contact by staff, may be employed only when necessary to protect the person receiving services from injury to self or others. Physical restraint may not be employed as punishment, for the convenience of staff, or as a substitute for a program of services and supports. Physical guidance or prompting techniques of short duration such as those employed in training techniques are not considered physical restraint. Physical restraint may be applied only if alternative techniques have failed and only if such restraint imposed the least possible restriction consistent with its purpose. If physical restraint is used in an emergency or on a continuing basis its use shall be reviewed by the interdisciplinary team and the human rights committee in accordance with the rules of the state board.

(9) The use of a mechanical restraint, defined as the use of mechanical devices intended to restrict the movement or normal functioning of a portion of a person's body, is subject to special review and oversight, as defined in rules. Use of mechanical restraints may be applied only in an emergency if alternative techniques have failed and in conjunction with a behavior development program. Mechanical restraints must be designed and used so as not to cause physical injury to the person receiving services and so as to cause the least possible discomfort. The use of mechanical restraints shall be reviewed by the human rights committee. The use of posey vests, straight jackets, ankle and wrist restraints, and other devices defined in rules is prohibited.

(10) A record must be maintained of all physical injuries to any person receiving services, all incidents of mistreatment, exploitation, neglect, or abuse, and all uses of physical or mechanical restraint. All records are subject to review by the human rights committee.

(11) Behavior development programs must be supervised by an intellectual and developmental disabilities professional having specific knowledge and skills to develop and implement positive behavioral intervention strategies.
C.R.S. § 25.5-6-207 — CO Code / Title 25.5 / Article 6 / Part 2 / Section 25.5-6-207
25.5-6-207. Class I nursing facility reimbursement rates - study - report - repeal
Status: repealed

25.5-6-207. Class I nursing facility reimbursement rates - study - report - repeal. (Repealed)
C.R.S. § 25.5-3-501 — CO Code / Title 25.5 / Article 3 / Part 5 / Section 25.5-3-501
25.5-3-501. Definitions
Status: repealed

25.5-3-501. Definitions. As used in this part 5, unless the context otherwise requires:

(1) "Health-care facility" means:

(a) A hospital licensed as a general hospital pursuant to part 1 of article 3 of title 25;

(b) A hospital established pursuant to section 23-21-503 or 25-29-103;

(c) [Editor's note: This version of subsection (1)(c) is effective until July 1, 2026.] Any freestanding emergency department licensed pursuant to section 25-1.5-114; or

(c) [Editor's note: This version of subsection (1)(c) is effective July 1, 2026.] Any freestanding emergency department licensed pursuant to section 25-1.5-114;

(d) Any outpatient health-care facility that is licensed as an on-campus department or service of a hospital or that is listed as an off-campus location under a hospital's license, except:

(I) A federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4); or

(II) [Editor's note: This version of subsection (1)(d)(II) is effective until July 1, 2026.] A student-learning medical and dental clinic that is established for the purpose of student learning, offering discounted patient care as part of a program of student learning, and is physically situated within a health sciences school.

(II) [Editor's note: This version of subsection (1)(d)(II) is effective July 1, 2026.] A student-learning medical and dental clinic that is established for the purpose of student learning and offering discounted patient care as part of a program of student learning and is physically situated within a health sciences school; or

(e) [Editor's note: Subsection (1)(e) is effective July 1, 2026.] A critical access hospital as defined in section 25-1.5-114.5.

(2) "Health-care services" has the same meaning as set forth in section 10-16-102 (33).

(2.5) "Inpatient hospital service" has the same meaning as set forth in 42 CFR 440.10.

(3) "Licensed health-care professional" means any health-care professional who is registered, certified, or licensed pursuant to title 12 or who provides services under the supervision of a health-care professional who is registered, certified, or licensed pursuant to title 12, and who provides health-care services in a health-care facility.

(4) Repealed.

(4.5) "Outpatient hospital service" has the same meaning as set forth in 42 CFR 440.20.

(5) "Qualified patient" means an individual who attests to residing in Colorado whose household income is not more than two hundred fifty percent of the federal poverty level and who received an inpatient hospital service or outpatient hospital service at a health-care facility.

(6) "Screen" or "screening" means a process identified in rule by the state department whereby health-care facilities assess a patient's circumstances related to eligibility criteria and determine whether the patient is likely to qualify for public health-care coverage or discounted care, inform the patient of the health-care facility's determination, and provide information to the patient about how the patient can enroll in public health-care coverage.

(7) "Uninsured" means an uninsured individual, as defined in section 10-22-113 (5)(d).
C.R.S. § 25.5-6-701 — CO Code / Title 25.5 / Article 6 / Part 7 / Section 25.5-6-701
25.5-6-701. Short title
Status: in_force

25.5-6-701. Short title. This part 7 shall be known and may be cited as the "Home- and Community-based Services for Persons with Brain Injury Act".
C.R.S. § 25.5-1-121 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-121
25.5-1-121. County expenditures - advancements - procedures
Status: in_force

25.5-1-121. County expenditures - advancements - procedures. (1) For purposes of this article, under rules of the state department, administrative costs shall include: Salaries of the county director and employees of the county department staff engaged in the performance of medical assistance activities; the county's payments on behalf of such employees for old age and survivors' insurance or pursuant to a county officers' and employees' retirement plan and for any health insurance plan, if approved by the state department; the necessary travel expenses of the county board and the administrative staff of the county department in the performance of their duties; necessary telephone and other electronic means of communication; necessary equipment and supplies; necessary payments for postage and printing, including the printing and preparation of county warrants required for the administration of the county department; and such other administrative costs as may be approved by the state department; but advancements for office space, utilities, and fixtures may be made from state funds only if federal matching funds are available.

(2) Notwithstanding any other provision of this article, the county department may spend in excess of twenty percent of actual costs for the purpose of matching federal funds for the administration of the child support enforcement program or for the administrative costs of activities involving food stamp, public assistance, or medical assistance fraud investigations or prosecutions.

(3) (a) Notwithstanding any other provision of this article, the county department may receive and spend federal funds to which it is entitled based on the county's certification of public expenditures for administrative costs made by other entities within the county, which expenditures:

(I) Are from sources other than the county social services fund;

(II) Are in excess of the county department's portion, as required pursuant to section 25.5-1-114 (2)(a), of the administrative costs; and

(III) Are for an administrative activity that has been approved by the state department as an activity that is eligible for reimbursement under a federal program.

(b) Acceptance and expenditure of federal funds pursuant to paragraph (a) of this subsection (3) shall not affect the state's share of and contribution to the administrative costs. The county shall be solely responsible for certifying the nonfederal share that is in excess of the county's required portion of the administrative costs. The state department may retain up to five percent of any federal funds received by a county department pursuant to this subsection (3). In addition, the state, in accordance with the provisions of section 26-1-109 (4)(d), C.R.S., shall recover any federal funds received by the county through the certification of public expenditures that are subsequently determined to be ineligible for federal reimbursement.
C.R.S. § 25.5-10-218 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-218
25.5-10-218. Persons' rights
Status: in_force

25.5-10-218. Persons' rights. (1) Unless a person's rights are modified by court order, a person with an intellectual and developmental disability has the same legal rights and responsibilities guaranteed to all other persons under the federal and state constitutions and federal and state laws. No otherwise qualified person, by reason of having an intellectual and developmental disability, may be excluded from participation in, denied the benefits of, or subjected to discrimination under any program or activity which receives public funds.

(2) The receipt of services and supports pursuant to this article does not deprive any person of any other rights, benefits, or privileges or cause the person to be declared legally incompetent.

(3) The rights of any person receiving services which are specified in this article 10 may be modified to protect the person receiving services from endangering the person, others, or property. The rights may be modified only with the informed consent of the person receiving services or the person's legally authorized representative and with subsequent review by the person receiving services, the person's legally authorized representative, the person's interdisciplinary team, and by the human rights committee in order to provide specific services or supports to the person receiving services, which will promote the least restriction on the person's rights. The person's legal rights may be removed by a court pursuant to section 25.5-10-216.

(4) None of the rights established pursuant to this article shall be construed to interfere with the rights and privileges of parents regarding their minor child.
C.R.S. § 25.5-1-131 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-131
25.5-1-131. Insurance ombudsman - consumer advocate - duties
Status: in_force

25.5-1-131. Insurance ombudsman - consumer advocate - duties. (1) There is hereby created in the state department the office of the insurance ombudsman to act as the advocate for consumer interests in matters related to access to and the affordability of the standardized health benefit plan created pursuant to section 10-16-1304. The ombudsman shall:

(a) Interact with consumers regarding their access to, the affordability of, and coverage issues with the standardized plan;

(b) Evaluate data to assess the standardized plan's network and affordability; and

(c) Represent the interests of consumers in public hearings held pursuant to section 10-16-1306.

(2) In the performance of the ombudsman's duties, the ombudsman shall act independently of the state department. Any recommendations made or positions taken by the ombudsman do not reflect those of the state department.
C.R.S. § 25.5-8-102 — CO Code / Title 25.5 / Article 8 / Section 25.5-8-102
25.5-8-102. Legislative declaration
Status: in_force

25.5-8-102. Legislative declaration. (1) The general assembly hereby finds and declares that a significant percentage of children are uninsured. This lack of health insurance coverage decreases children's access to preventive health-care services, compromises the productivity of the state's future workforce, and results in avoidable expenditures for emergency and remedial health care. Health-care providers, health-care facilities, and all purchasers of health care, including the state, bear the costs of this uncompensated care.

(2) [Editor's note: This version of subsection (2) is effective until July 1, 2025.] The general assembly further finds and declares that the coordination and consolidation of funding sources currently available to provide services to uninsured children such as the Colorado indigent care program pursuant to part 1 of article 3 of this title, the children's basic health plan, and other children's health programs would efficiently and effectively meet the health-care needs of uninsured children and would help to reduce the volume of uncompensated care in the state.

(2) [Editor's note: This version of subsection (2) is effective July 1, 2025.] The general assembly further finds and declares that the coordination and consolidation of funding sources currently available to provide services to uninsured children such as the children's basic health plan, and other children's health programs would efficiently and effectively meet the health-care needs of uninsured children and would help to reduce the volume of uncompensated care in the state.

(3) (a) It is the intent of the general assembly to make health insurance coverage available and affordable and to support employers in their efforts to provide their employees and their dependents with health insurance coverage and to support increased availability of affordable health insurance in the individual market.

(b) It is the intent of the general assembly that the savings and efficiencies realized through actual reductions in administrative and programmatic costs associated with the implementation of this article and achieved in consolidating other health-care programs should be identified.

(4) It is not the intent of the general assembly to create an entitlement for health insurance coverage.

(5) The general assembly hereby declares that the following principles shall be used in implementing the children's basic health plan set forth in this article:

(a) The department shall establish and maintain a goal of inter-program communication in order to maximize existing state appropriations for the population served in the program;

(b) There shall be efficient program utilization through inter-program coordination and program consolidation and, where appropriate, through contracting with the private sector and with essential community providers;

(c) The policies enacted in House Bill 97-1304 regarding a strong managed care direction shall be emphasized;

(d) The private sector shall be involved to the greatest possible degree with respect to contracting for managed care;

(e) There shall be maximum emphasis on coordination with local and state public health programs and initiatives for children.

(6) The general assembly hereby finds and declares:

(a) That the goal of the "Children's Basic Health Plan Act" is to support low-income, working parents and families in overcoming barriers in obtaining good quality, affordable health-care services for their children;

(b) That the health services that low-income children receive through the children's basic health plan should be cost-effective, of high quality, and promote positive health outcomes for enrolled children;

(c) That the children's basic health plan was designed as, and should continue to be, a private-public partnership that encourages enrollment and seeks every opportunity to operate with the efficiency and creativity that is found in utilizing private sector systems and business practices while maintaining the highest level of accountability to the general assembly, the executive branch, and the public through administration of the plan by the department;

(d) That the children's basic health plan was designed as, and should continue to be, a community-based program that encourages local participation in enrolling children in and supporting its goals.
C.R.S. § 25.5-4-425 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-425
25.5-4-425. Providers - health-care services related to labor and delivery - reimbursement
Status: in_force

25.5-4-425. Providers - health-care services related to labor and delivery - reimbursement. (1) The state department shall reimburse all eligible providers that provide health-care services related to labor and delivery within the scope of the provider's practice in a manner that:

(a) Promotes high-quality, cost-effective, and evidence-based care;

(b) Promotes high-value, evidence-based payment models; and

(c) Prevents risk in subsequent pregnancies.
C.R.S. § 25.5-10-239 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-239
25.5-10-239. Evaluations to determine whether a defendant is mentally retarded or has an inte
Status: in_force

25.5-10-239. Evaluations to determine whether a defendant is mentally retarded or has an intellectual and developmental disability for purposes of class 1 felony trials. Upon request of the court, the executive director, or his or her designee, shall recommend specific professionals who are qualified to perform an evaluation to determine whether a defendant is mentally retarded or is a defendant with an intellectual and developmental disability, as defined in section 18-1.3-1101. A recommended professional must be licensed as a psychologist in the state of Colorado and must have experience in and demonstrated competence in determination and evaluation of persons with intellectual and developmental disabilities. The executive director shall convene a panel of not fewer than three persons with expertise in intellectual and developmental disabilities to assess the qualifications of licensed psychologists and make recommendations to the executive director or his or her designee.
C.R.S. § 25.5-6-1102 — CO Code / Title 25.5 / Article 6 / Part 11 / Section 25.5-6-1102
25.5-6-1102. Service model - consumer-directed care - repeal
Status: repealed

25.5-6-1102. Service model - consumer-directed care - repeal. (1) The state department shall implement a consumer-directed care service model that allows eligible persons to receive a direct payment through a voucher to purchase qualified services. The state department is authorized to seek any federal waivers or waiver amendments that may be necessary to implement this part 11. The state department shall design and implement the consumer-directed care service model with input from consumers of home- and community-based services or their authorized representatives. An eligible person shall not be required to disenroll from the person's waiver program in order to receive qualified services through the consumer-directed care service model.

(2) In order to qualify and to remain eligible for the consumer-directed care service model authorized by this section, a person shall:

(a) [Editor's note: This version of subsection (2)(a) is effective until July 1, 2025.] Be eligible for home- and community-based services under parts 3 to 12 of this article or any other home- and community-based service waiver for which the state department has federal waiver authority;

(a) [Editor's note: This version of subsection (2)(a) is effective July 1, 2025.] Be eligible for community first choice services pursuant to part 19 of this article 6;

(b) Be willing to participate;

(c) Obtain a statement from his or her primary care physician or advanced practice registered nurse indicating that the person has sound judgment and the ability to direct his or her care or has an authorized representative;

(d) Demonstrate the ability to handle the financial aspects of self-directed care or has an authorized representative who is able to handle the financial aspects of the eligible person's care; and

(e) Meet any other qualifications established by the state board by rule.

(3) [Editor's note: This version of subsection (3) is effective until July 1, 2025.] The voucher issued to the eligible person pursuant to this part 11 must be based on the eligible person's historical utilization of home- and community-based services pursuant to parts 3 to 12 of this article 6, the case management agency's care plan, or any approved resource allocation process as determined by the state department and the department of human services for the eligible person.

(3) [Editor's note: This version of subsection (3) is effective July 1, 2025.] The allocation issued to the eligible person pursuant to this part 11 must be based on the eligible person's historical utilization of home- and community-based services pursuant to parts 3 to 12 of this article 6, the case management agency's care plan, or any approved resource allocation process as determined by the state department and the department of human services for the eligible person.

(4) While an eligible person is participating in the consumer-directed care service model established in this part 11, that person shall be ineligible to receive a home care allowance as provided in section 26-2-122.3 (1)(b), C.R.S.

(5) The state department shall develop the accountability requirements necessary to safeguard the use of public dollars, to promote effective and efficient delivery of services, and to monitor the safety and welfare of eligible persons under this part 11.

(6) The state board shall adopt rules as necessary for the implementation and administration of the consumer-directed care service model authorized by this part 11. Such rules shall include a provision allowing an eligible person to designate a family member or authorized representative to be responsible for managing the financial matters associated with the consumer-directed care or to direct the eligible person's care. The designee shall not receive reimbursement for managing the financial matters associated with the eligible person's care or for directing the eligible person's care.

(7) Sections 12-255-104 (7), (8.5), and (11), 12-255-125 (1), and 12-255-214 (1)(b) shall not apply to a person who is directly employed by an individual participating in the consumer-directed care service model pursuant to this section and who is acting within the scope and course of such employment. However, such person may not represent himself or herself to the public as a licensed nurse, a certified nurse aide, a licensed practical or professional nurse, a registered nurse, or a registered professional nurse. This exclusion shall not apply to any person who has had his or her license as a nurse or certification as a nurse aide suspended or revoked or his or her application for such license or certification denied.

(8) (a) Section 25.5-6-310 does not apply to a family member of an eligible person who provides consumer-directed care services to the eligible person pursuant to this part 11.

(b) This subsection (8) is repealed, effective July 1, 2025.

(9) A person who has been designated as an authorized representative under this part 11 shall submit an affidavit, which shall become part of the eligible person's file, stating that:

(a) He or she is at least eighteen years of age;

(b) He or she has known the eligible person for at least two years;

(c) He or she has not been convicted of any crime involving exploitation, abuse, or assault on another person; and

(d) He or she does not have a mental, emotional, or physical condition that could result in harm to the eligible person.
C.R.S. § 25.5-1-201 — CO Code / Title 25.5 / Article 1 / Part 2 / Section 25.5-1-201
25.5-1-201. Programs to be administered by the department of health care policy and financin
Status: repealed

25.5-1-201. Programs to be administered by the department of health care policy and financing - repeal. (1) The state department shall administer the following programs and perform the following functions:

(a) The "Colorado Medical Assistance Act", as specified in articles 4, 5, and 6 of this title;

(b) (I) The "Colorado Indigent Care Program", as specified in part 1 of article 3 of this title;

(II) This subsection (1)(b) is repealed, effective July 1, 2025.

(c) Effective July 1, 1996, school entry immunization, as specified in part 9 of article 4 of title 25, C.R.S. Commencing on and after the fiscal year beginning July 1, 1996, the state department is authorized to contract with the department of public health and environment for the purpose of enforcing the school entry immunization requirements.

(d) Repealed.

(e) The "Children's Basic Health Plan Act", as specified in article 8 of this title;

(f) The old age pension health and medical care program, as specified in section 25.5-2-101;

(f.5) The reproductive health-care program that provides reproductive health-care services, as specified in section 25.5-2-103;

(g) Programs, services, and supports for persons with intellectual and developmental disabilities, as specified in article 10 of this title 25.5; and

(h) Any program concerning the wholesale importation of prescription drugs pursuant to part 2 of article 2.5 of this title 25.5.
C.R.S. § 25.5-6-308 — CO Code / Title 25.5 / Article 6 / Part 3 / Section 25.5-6-308
25.5-6-308. Cost of services
Status: in_force

25.5-6-308. Cost of services. Home- and community-based services for the elderly, blind, and disabled shall meet aggregate federal waiver budget neutrality requirements.
C.R.S. § 25.5-6-303 — CO Code / Title 25.5 / Article 6 / Part 3 / Section 25.5-6-303
25.5-6-303. Definitions - repeal
Status: repealed

25.5-6-303. Definitions - repeal. As used in this part 3, unless the context otherwise requires:

(1) "Adult day care facility" means a facility which meets all applicable state and federal requirements and is certified by the state to provide adult day care services to eligible persons.

(2) "Adult day care services" means health and social services provided on a less than twenty-four-hour basis to eligible persons in state-certified adult day care facilities.

(3) "Alternative care facility" means a residential facility which provides alternative care services and protective oversight to eligible persons, which meets applicable state and federal requirements, and which is state-certified.

(4) "Alternative care services" means a package of personal care and homemaker services provided in a state-certified alternative care facility.

(5) (a) "Case management agency" means agencies providing services on and before July 1, 1995, for home- and community-based programs for the elderly, blind, and disabled shall be terminated July 1, 1995, and case management functions shall thereafter be performed in accordance with this article 6.

(b) "Case management agency" has the same meaning as set forth in section 25.5-6-1702 (2).

(6) "Case management services" has the same meeting as set forth in section 25.5-6-1702 (3).

(7) "Case plan" means a coordinated plan for the provision of long-term-care services in a setting other than a nursing home, developed and managed by a case management agency, in coordination with the member, the member's family or guardian, the member's physician, and other providers of care.

(8) (a) "Electronic monitoring provider" means an entity that meets applicable state, federal, and local requirements and is certified to provide electronic monitoring services.

(b) This subsection (8) is repealed, effective July 1, 2025.

(9) (a) "Electronic monitoring services" means electronic equipment or adaptations or other remote supports that are related to an eligible person's disability and enable the person to remain at home.

(b) This subsection (9) is repealed, effective July 1, 2025.

(10) (a) "Homemaker agency" means any agency that meets applicable state and federal requirements and is state-certified to provide homemaker services.

(b) This subsection (10) is repealed, effective July 1, 2025.

(11) (a) "Homemaker services" means general household activities that are provided by state-certified agencies to maintain a healthy and safe home environment for eligible persons.

(b) This subsection (11) is repealed, effective July 1, 2025.

(12) "Home modification provider" means an entity that meets applicable state, federal, and local requirements and is certified to provide home modification services.

(13) "Home modification services" means home installations or adaptations that are related to the eligible person's physical impairment and enable the person to remain at home.

(14) "Medications administration" means the administration or monitoring of medications provided in a manner consistent with part 3 of article 1.5 of title 25, C.R.S., under the authority and direction of the state department, as part of the "alternative care services", as defined in subsection (4) of this section, as provided in an "alternative care facility", as defined in subsection (3) of this section.

(15) "Nonmedical transportation provider" means an entity that meets applicable state and federal requirements and is certified to provide nonmedical transportation services.

(16) "Nonmedical transportation services" means transportation of eligible persons to services such as, but not limited to, adult day care services, which enable the person to remain at home.

(17) (a) "Personal care agency" means any agency that meets state and federal requirements and is state-certified to provide personal care services.

(b) This subsection (17) is repealed, effective July 1, 2025.

(18) (a) "Personal care services" means services to meet an eligible person's physical requirements and functional needs, when such services do not require the supervision of a nurse.

(b) This subsection (18) is repealed, effective July 1, 2025.

(19) "Respite care provider" means a facility or agency that meets all applicable state and federal requirements and is state-certified to provide respite care services.

(20) "Respite care services" means services of a short-term nature provided to a member, in the home or in a facility approved by the state department, in order to temporarily relieve the family or other home providers from the care and maintenance of the member, including room and board, maintenance, personal care, and other related services.

(21) Repealed.
C.R.S. § 25.5-10-209.3 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-209.3
25.5-10-209.3. Cross-system behavioral health crisis response - comprehensive care coordination
Status: in_force

25.5-10-209.3. Cross-system behavioral health crisis response - comprehensive care coordination and treatment model - training - legislative declaration. (1) (a) The general assembly declares that persons with intellectual and developmental disabilities and co-occurring behavioral health diagnoses and needs:

(I) Experience limited access to appropriate treatment, including crisis intervention, stabilization, and prevention, and such individuals who live in rural areas of Colorado are particularly impacted by this limited access to appropriate treatment;

(II) Deserve to live, work, play, and thrive in their communities;

(III) Require a heightened level of care;

(IV) Require evidence-based treatment to help lead full lives within their communities; and

(V) Experience significant gaps in care, including a lack of access to appropriate treatment.

(b) Therefore, as a preliminary measure to close these gaps in care, the general assembly finds that the state must invest in extensive, expanded training using a comprehensive model of care that is available via teleconference. The training must be available for up to thirty individuals across the state in order to adequately address the limited access to treatment in rural areas.

(2) (a) As soon as possible, the state department shall obtain a vendor to provide extensive statewide training to professional persons who work with persons with intellectual and developmental disabilities and co-occurring behavioral health needs.

(b) A qualified vendor must:

(I) Utilize a comprehensive care coordination and treatment model that is evidence-based;

(II) Be able to show demonstrated success in multiple states;

(III) Have experience with rural issues;

(IV) Have at least ten years of experience working with professionals who work with individuals with intellectual and developmental disabilities;

(V) Maintain a national database that involves the standardized collection, analysis, and reporting of outcomes associated with the impact of the training on the individuals being served; and

(VI) Be able to provide the training statewide using teleconference technology.

(3) (a) No later than sixty calendar days after a vendor is obtained pursuant to subsection (2)(a) of this section, case management agencies, mental health centers, and other program-approved service agencies in the state shall nominate one provider in their geographic service area to be trained in the comprehensive care coordination and treatment model designed and provided by the vendor selected pursuant to subsection (2) of this section. Up to twenty providers may be selected for training pursuant to this subsection (3)(a). Selected providers must have a clinical background and prior experience working with the intellectual and developmental disabilities population. If more than twenty providers are nominated through this process, the state department shall make final selections, giving preference to providers in underserved areas.

(b) The state department shall coordinate with case management agencies in underserved areas of the state to select an additional ten providers to be trained in the comprehensive care coordination and treatment model.

(4) Participating providers shall complete the training provided no later than one calendar year after a provider is nominated pursuant to subsection (3)(a) of this section.

(5) The state department shall reimburse participating providers at the provider's current pay rate for time spent in training.
C.R.S. § 25.5-6-110 — CO Code / Title 25.5 / Article 6 / Part 1 / Section 25.5-6-110
25.5-6-110. Private-public partnership education and information program concerning long-ter
Status: in_force

25.5-6-110. Private-public partnership education and information program concerning long-term care insurance authorized. (1) The general assembly hereby declares that:

(a) A large number of Coloradans are in need of long-term health care;

(b) The cost of long-term care, especially nursing home care, is significant;

(c) Many persons in need of long-term care are ineligible for state medical assistance due to countable resources. When faced with the need for long-term care, such persons expend such resources to pay for nursing home care.

(d) A person's resources may cover only a relatively short period of care, often resulting in rendering such person impoverished, and after which time the person must rely on state medical assistance;

(e) Expenditures for long-term care represent a significant portion of the state's medical assistance budget;

(f) Unless Colorado implements new methods for financing long-term care, which methods include participation by the private sector, the cost to the state for long-term care will increase astronomically; and

(g) It is therefore appropriate to enact legislation that allows the state department, upon a determination by the executive director of the state department that it is feasible, to design and implement a private-public partnership for financing long-term care in this state.

(2) The state department shall cooperate with the division of insurance in the department of regulatory agencies in a private-public partnership for financing long-term care in this state through the availability of long-term care insurance policies that result in a reduction of total dependency on the medical assistance program to finance such care. It is the general assembly's intent that such partnership shall be designed to encourage individuals to purchase long-term care insurance, which, with respect to middle to higher income individuals, will have the result of eliminating or delaying the individual's need for medical assistance.

(3) Under the partnership described in subsection (2) of this section, the division of insurance shall implement statutory changes to article 19 of title 10, C.R.S., concerning long-term care policies that the general assembly hereby declares are necessary to accomplish the purpose of the partnership described in this section. In addition, the state department is encouraged to implement a public education-awareness program based on recommendations from an advisory committee that the executive director of the state department is hereby authorized to establish.

(4) The state department is authorized to seek and accept funds, grants, or donations from any private entity for implementing the public education-awareness program. In addition, if necessary, the state department may assess a fee in connection with conducting any public education-awareness training program or seminar. Any such fee collected shall be transmitted to the state treasurer, who shall credit the same to the long-term care insurance fund, which fund is hereby created. The moneys in the fund shall be subject to annual appropriation by the general assembly for the sole purpose of public education-awareness training programs and seminars.

(5) In addition to administering the public education-awareness program under the partnership, the state department shall seek a federal waiver from the requirement of section 13612 of the federal "Omnibus Budget Reconciliation Act of 1993" (OBRA), Public Law 103-66, that prevents the state department from granting medical assistance applicants a full or partial resource exemption in determining eligibility for medical assistance and an exemption from estate recovery requirements.

(6) The state department, if funds are available, shall contract with a public or private entity to conduct an evaluation of the public education-awareness program on or before December 1, 2000.

(7) With respect to a policyholder who has allowed his or her private long-term care insurance policy to lapse, if the person is found to be eligible for the medical assistance program, the state department is authorized to pay the premium for a reinstated policy pursuant to section 10-19-107 (2), C.R.S., if the state department finds that to do so is feasible and cost-efficient.
C.R.S. § 25.5-4-502 — CO Code / Title 25.5 / Article 4 / Part 5 / Section 25.5-4-502
25.5-4-502. Federal authorization - repeal
Status: repealed

25.5-4-502. Federal authorization - repeal. (Repealed)
C.R.S. § 25.5-4-214 — CO Code / Title 25.5 / Article 4 / Part 2 / Section 25.5-4-214
25.5-4-214. Feasibility study - residential and inpatient substance use disorder treatment -
Status: repealed

25.5-4-214. Feasibility study - residential and inpatient substance use disorder treatment - report - repeal. (Repealed)
C.R.S. § 25.5-4-419 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-419
25.5-4-419. Supplemental state payment to qualified providers - office-administered drugs -
Status: repealed

25.5-4-419. Supplemental state payment to qualified providers - office-administered drugs - no federal financial participation - definition - rules - repeal. (Repealed)
C.R.S. § 25.5-5-425 — CO Code / Title 25.5 / Article 5 / Part 4 / Section 25.5-5-425
25.5-5-425. Audit of MCE denials for residential and inpatient substance use disorder treatm
Status: in_force

25.5-5-425. Audit of MCE denials for residential and inpatient substance use disorder treatment authorization - report. (1) No later than July 1, 2022, the state department shall contract with an independent third-party vendor to audit thirty-three percent of all denials of authorization for inpatient and residential substance use disorder treatment for each MCE.

(2) Beginning no later than January 31, 2025, and no later than each January 31 thereafter, the state department shall submit the results of the audit conducted pursuant to subsection (1) of this section and any recommended changes to the residential and inpatient substance use disorder benefit to the house of representatives health and human services committee, the senate health and human services committee, or their successor committees, and the joint budget committee.
C.R.S. § 25.5-5-518 — CO Code / Title 25.5 / Article 5 / Part 5 / Section 25.5-5-518
25.5-5-518. Coverage for choline dietary supplements - rules
Status: in_force

25.5-5-518. Coverage for choline dietary supplements - rules. (1) No later than July 1, 2025, the state board shall promulgate rules to include coverage under the medical assistance program for over-the-counter choline dietary supplements for pregnant persons.

(2) The state department shall seek federal approval, as necessary, for the coverage described in subsection (1) of this section.
C.R.S. § 25.5-6-1801 — CO Code / Title 25.5 / Article 6 / Part 18 / Section 25.5-6-1801
25.5-6-1801. Legislative declaration
Status: in_force

25.5-6-1801. Legislative declaration. (1) The general assembly finds and declares that Colorado has a long-standing commitment to serving older adults and people with disabilities through home- and community-based services that enable them to stay in their homes in their communities.

(2) Therefore, the general assembly declares that Colorado is committed to maximizing the impact of the one-time, ten-percentage-point increase in the federal matching rate for medicaid home- and community-based services, as outlined in section 9817 of the federal "American Rescue Plan Act of 2021", to implement or supplement the implementation of one or more activities to enhance, expand, and strengthen medicaid-funded home- and community-based services.
C.R.S. § 25.5-5-803 — CO Code / Title 25.5 / Article 5 / Part 8 / Section 25.5-5-803
25.5-5-803. High-fidelity wraparound services for children and youth - federal approval - re
Status: in_force

25.5-5-803. High-fidelity wraparound services for children and youth - federal approval - reporting. (1) Subject to available appropriations, the state department shall seek federal authorization from the federal centers for medicare and medicaid services to provide wraparound services for eligible children and youth who are at risk of out-of-home placement or in an out-of-home placement. Prior to seeking federal authorization, the state department shall seek input from relevant stakeholders including counties, managed care entities participating in the statewide managed care system, families of children and youth with behavioral health disorders, communities that have previously implemented wraparound services, mental health professionals, the behavioral health administration in the department of human services, and other relevant departments. The state department shall consider tiered care coordination as an approach when developing the wraparound model.

(2) Upon federal authorization, and subject to available appropriations, the state department shall require managed care entities to implement wraparound services, which may be contracted out to a third party. Subject to available appropriations, the state department shall contract with the department of human services and the behavioral health administration in the department of human services to ensure care coordinators and those responsible for implementing wraparound services have adequate training and resources to support children and youth who may have co-occurring diagnoses, including behavioral health disorders and physical or intellectual or developmental disabilities. Attention must also be given to the geographic diversity of the state in designing this program in rural communities.

(3) Upon implementation of the wraparound services, the state department, the department of human services, and the behavioral health administration in the department of human services shall monitor and report the annual cost savings associated with eligible children and youth receiving wraparound services to the public through the annual hearing, pursuant to the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act", part 2 of article 7 of title 2. The state department shall require managed care entities to report data on the utilization and effectiveness of wraparound services.

(4) Subject to available appropriations, the state department shall work collaboratively with the department of human services, the behavioral health administration in the department of human services, counties, and other departments, as appropriate, to develop and implement wraparound services for children and youth at risk of out-of-home placement or in an out-of-home placement. The behavioral health administration in the department of human services shall oversee that the wraparound services are delivered with fidelity to the model. As part of routine collaboration, and subject to available appropriations, the state department shall develop a model of sustainable funding for wraparound services in consultation with the department of human services and the behavioral health administration in the department of human services. Wraparound services provided to eligible children and youth pursuant to this section must be covered under the "Colorado Medical Assistance Act", articles 4, 5, and 6 of this title 25.5, subject to available appropriations. The state department may use targeting criteria to ramp up wraparound services as service capacity increases, or temporarily, as necessary, to meet certain federal financial participation requirements.
C.R.S. § 25.5-4-307 — CO Code / Title 25.5 / Article 4 / Part 3 / Section 25.5-4-307
25.5-4-307. False medicaid claims procedures - statute of limitations
Status: in_force

25.5-4-307. False medicaid claims procedures - statute of limitations. (1) A civil action under section 25.5-4-306 (1) or (2) may not be brought after the later of:

(a) More than six years after the date on which the violation of section 25.5-4-305 is committed; or

(b) More than three years after the date when facts material to the right of action are known or reasonably should have been known by the official of the state charged with responsibility to act in the circumstances, but in no event more than ten years after the date on which the violation of section 25.5-4-305 is committed.

(2) If the state elects to intervene and proceed with an action brought under section 25.5-4-306, the state may file its own complaint or amend the relator's complaint to clarify or add detail to the claims in which the state is intervening and to add any additional claims with respect to which the state contends it is entitled to relief. For statute of limitations purposes, any such pleadings by the state shall relate back to the filing date of the relator's complaint, to the extent that the state's claim arises out of the conduct, transactions, or occurrences set forth, or attempted to be set forth, in the prior complaint of the relator.

(3) In an action brought under section 25.5-4-306, the state or relator must prove all essential elements of the cause of action, including damages, by a preponderance of the evidence.

(4) Notwithstanding any other provision of law, the Colorado rules of criminal procedure, or the Colorado rules of evidence, a final judgment rendered in favor of the state in a criminal proceeding charging fraud or false statements, whether upon a verdict after trial or upon a plea of guilty or nolo contendere, shall estop the defendant from denying the essential elements of the offense in any action that involves the same transaction as in the criminal proceeding and that is brought under section 25.5-4-306.

(5) A private action for retaliation under section 25.5-4-306 (7) may not be brought more than three years after the date when the retaliation occurred.
C.R.S. § 25.5-6-305 — CO Code / Title 25.5 / Article 6 / Part 3 / Section 25.5-6-305
25.5-6-305. Provision of services for elderly and blind individuals and individuals with dis
Status: in_force

25.5-6-305. Provision of services for elderly and blind individuals and individuals with disabilities. The provision of the services set forth in this part 3 shall be subject to the availability of federal matching medicaid funds, pursuant to Title XIX of the federal "Social Security Act", as amended, for payment of the costs for administration and costs for the provision of such services.
C.R.S. § 25.5-1-101 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-101
25.5-1-101. Short title
Status: in_force

25.5-1-101. Short title. This title shall be known and may be cited as the "State Health Care Policy and Financing Act".
C.R.S. § 25.5-2.5-105 — CO Code / Title 25.5 / Article 2.5 / Part 1 / Section 25.5-2.5-105
25.5-2.5-105. Cash fund
Status: repealed

25.5-2.5-105. Cash fund. (Repealed)
C.R.S. § 25.5-2.5-208 — CO Code / Title 25.5 / Article 2.5 / Part 2 / Section 25.5-2.5-208
25.5-2.5-208. Expansion of program to include additional foreign suppliers - federal action re
Status: in_force

25.5-2.5-208. Expansion of program to include additional foreign suppliers - federal action required - notice to general assembly. (1) Notwithstanding any provision of this part 2 to the contrary, the state department may expand the program to allow a manufacturer, wholesale distributor, or pharmacy from a nation other than Canada to export prescription drugs into the state under the program if:

(a) The United States congress enacts legislation to amend 21 U.S.C. sec. 384 or otherwise enacts legislation to permit states, including Colorado, to import prescription drugs from foreign countries other than Canada;

(b) A vendor, in consultation with the state department, has identified the manufacturer, wholesale distributor, or pharmacy as a supplier that satisfies the requirements of the program and that will export prescription drugs at prices that will provide cost savings to the state;

(c) The manufacturer, wholesale distributor, or pharmacy is appropriately licensed or permitted under that nation's laws and regulations pertaining to the manufacturing, distribution, or dispensing of prescription drugs;

(d) The manufacturer, wholesale distributor, or pharmacy is located in a nation that is approved to export prescription drugs into Colorado by the United States secretary of health and human services or by another authority that is designated for such purpose by federal law; and

(e) The state department submits evidence to the president of the senate, the speaker of the house of representatives, and the health and human services committee of the senate and the health and insurance committee of the house of representatives, or any successor committees, which evidence compares the exporting nation's regulatory system for prescription drugs to the regulatory system for prescription drugs administered by the United States food and drug administration pursuant to the federal act and demonstrates that the exporting nation's regulatory system is as stringent as the system in the United States or otherwise ensures the safety, purity, and potency of the prescription drugs from the exporting nation. The evidence must compare the regulations for:

(I) Securing the supply chain for prescription drugs;

(II) Prescription drug manufacturing;

(III) Prescription drug labeling; and

(IV) Prescription drug tracking and tracing.

(2) If, upon the satisfaction of the conditions described in subsection (1) of this section, the state department decides to expand the program to allow a manufacturer, wholesale distributor, or pharmacy from a nation other than Canada to export prescription drugs into the state under the program, the executive director shall notify the president of the senate, the speaker of the house of representatives, and the health and human services committee of the senate and the health and insurance committee of the house of representatives, or any successor committees, of the state department's intent to do so. The executive director shall provide the notice at least thirty days before the program is expanded, and the notice may include any recommendations of the state department for legislation to amend this part 2 to reflect the expansion of the program.

(3) If the state department expands the program in accordance with this section, an eligible importer may import a prescription drug from a foreign supplier pursuant to this section if the drug that is to be imported is a prescription drug, as defined in 21 U.S.C. sec. 384 (a)(3).
C.R.S. § 25.5-10-222 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-222
25.5-10-222. Right to religious belief, practice, and worship
Status: in_force

25.5-10-222. Right to religious belief, practice, and worship. No person receiving services is required to perform any act or be subject to any procedure whatsoever which is contrary to the person's religious belief, and each such person has the right to practice such religious belief and be accorded the opportunity for religious worship. Provisions for religious worship must be made available to all persons receiving services on a nondiscriminatory basis. No such person shall be coerced into engaging in or refraining from any religious activity, practice, or belief.
C.R.S. § 25.5-4-423 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-423
25.5-4-423. Targets for investments in primary care
Status: in_force

25.5-4-423. Targets for investments in primary care. The state department shall adopt appropriate targets for investments in primary care to support value-based health-care delivery in alignment with the affordability standards developed in accordance with section 10-16-107 (3.5). The state department shall consider the recommendations of the primary care payment reform collaborative created in section 10-16-150. Targets established under this section do not apply in the case of a nonprofit, nongovernmental health maintenance organization with respect to managed care plans that provide a majority of covered professional services through a single contracted medical group.
C.R.S. § 25.5-6-1704 — CO Code / Title 25.5 / Article 6 / Part 17 / Section 25.5-6-1704
25.5-6-1704. Intellectual and developmental disability determination - functional eligibility
Status: in_force

25.5-6-1704. Intellectual and developmental disability determination - functional eligibility determination - rules. (1) Intellectual and developmental disability determination. Any person may request an evaluation to determine whether the person has a developmental delay or an intellectual and developmental disability and is eligible to receive long-term services and supports pursuant to this article 6 and article 10 of this title 25.5. The person must request a developmental delay determination or intellectual and developmental disabilities determination from the case management agency or the entity in the defined service area where the person resides.

(2) Functional eligibility determination. Pursuant to the contract with the state department, a case management agency shall determine whether a person is eligible to receive long-term services and supports pursuant to this article 6 and article 10 of this title 25.5. A case management agency or an entity shall develop a person-centered support plan for persons eligible for long-term services and supports for home- and community-based services and state general-funded programs.

(3) The state board shall promulgate rules pursuant to article 4 of title 24 setting forth the procedure and criteria for determination of eligibility and person-centered support plan development. The procedure and criteria must be uniform in nature and applied throughout the state in a consistent manner.

(4) Subject to available appropriations pursuant to section 25.5-10-206 and to the capacity of a service provider, the person must be provided options for long-term services and supports within the defined service area that can appropriately meet the person's identified needs, pursuant to this section.