C.R.S. § 25.5-6-402 — CO Code / Title 25.5 / Article 6 / Part 4 / Section 25.5-6-402
25.5-6-402. Legislative declaration - Prader-Willi syndrome
Status: repealed

25.5-6-402. Legislative declaration - Prader-Willi syndrome. (1) The general assembly finds and declares that it is the purpose of this part 4 to provide services for persons with intellectual and developmental disabilities that would foster the following goals:

(a) To maintain eligible persons in the most appropriate settings possible and to minimize admissions to institutions;

(b) To recognize the unique services requirements of persons with developmental disabilities;

(c) To provide optimum accessibility to various important social, habilitative, remedial, residential, and health services that are available to assist in maintaining eligible persons in the least restrictive settings;

(d) To provide eligible persons who have the capacity to remain outside an institutional setting access to appropriate social, habilitative, remedial, residential, and health services, without which institutionalization would be necessary;

(e) To provide the most efficient and effective use of funds in the delivery of these social, habilitative, remedial, residential, and health services to eligible persons;

(f) To coordinate, integrate, and link these social, habilitative, remedial, residential, and health services into existing community-based service delivery systems for persons with developmental disabilities, to avoid unnecessary and expensive duplication of services;

(g) To allow the state substantial flexibility in organizing and administering the delivery of social, habilitative, remedial, residential, and health services to eligible citizens.

(2) The general assembly intends that the state department and the department of human services shall cooperate to the maximum extent possible in designing, implementing, and administering the programs authorized under this part 4.

(3) Nothing in this part 4 shall be construed to disqualify persons from receiving any benefits to which they would otherwise be eligible under parts 1 and 2 of article 5 of this title, or under Title XIX of the federal "Social Security Act", as amended, by reason of being designated as a person with developmental disabilities.

(4) The general assembly further finds and declares that:

(a) Repealed.

(b) Because Prader-Willi syndrome is a genetic disorder, individuals either have it or they do not. Further, because there is not currently a cure, individuals who have Prader-Willi syndrome will have it for life.

(c) This disorder affects members of every culture, religion, economic class, race, and social order;

(d) The most critical hallmark of Prader-Willi syndrome is overeating. Individuals with Prader-Willi syndrome cannot tell when they are full and will continue to eat without stopping, leading to a ruptured stomach and even death. Other symptoms include significant developmental and cognitive delays, skin picking, sleep problems, obsessive-compulsive behaviors, hypothyroidism, hypogonadism, and low muscle tone.

(e) Repealed.
C.R.S. § 25.5-8-105 — CO Code / Title 25.5 / Article 8 / Section 25.5-8-105
25.5-8-105. Trust - created
Status: repealed

25.5-8-105. Trust - created. (1) A fund to be known as the children's basic health plan trust is hereby created and established in the state treasury. Except as provided for in subsection (8) of this section, all moneys deposited in the trust and all interest earned on moneys in the trust shall remain in the trust for the purposes set forth in this article, and no part thereof shall be expended or appropriated for any other purpose. The principal of the trust shall be expended, subject to annual appropriation by the general assembly, solely for the purposes set forth in this article.

(2) (a) Except as provided for in subsection (8) of this section, all or a portion of the moneys in the trust shall be annually appropriated by the general assembly for the purposes of this article and shall not be transferred to or revert to the general fund of the state at the end of any fiscal year.

(b) Notwithstanding the provisions of paragraph (a) of this subsection (2), moneys in the trust may be used to pay the state's portion of any computer system changes necessary to expand eligibility in the plan.

(3) (a) Pursuant to section 24-75-1104.5 (1.7)(b), C.R.S., and except as otherwise provided in section 24-75-1104.5 (5), C.R.S., beginning in the 2016-17 fiscal year and in each fiscal year thereafter so long as the state receives moneys pursuant to the master settlement agreement, the state treasurer shall transfer to the trust eighteen percent of the total amount of the moneys annually received by the state pursuant to the master settlement agreement, not including attorney fees and costs, during the preceding fiscal year. The state treasurer shall transfer the amount specified in this subsection (3) from moneys credited to the tobacco litigation settlement cash fund created in section 24-22-115, C.R.S. The amount transferred pursuant to this subsection (3) is in addition to and not in replacement of any general fund moneys appropriated to the trust.

(b) Repealed.

(4) Repealed.

(5) (a) Beginning in fiscal year 1998, appropriations to the trust may be made by the general assembly based on the savings achieved through reforms, consolidations, and streamlining of health-care programs realized through actual reductions in administrative and programmatic costs associated with the implementation of this article and not decreases in the number of caseloads of such programs. Beginning with and subsequent to fiscal year 2000-01, the general assembly may make annual appropriations to the trust.

(b) and (c) Repealed.

(6) As part of its annual savings report to the general assembly on November 1 of each year, the department may identify efficiencies and consolidations that produce savings in the department's annual budget request that result in actual reductions in administrative and programmatic costs associated with the implementation of this article and not decreases in the number of caseloads of such programs.

(7) The department may receive payment for coverage offered and may receive or contract for donations, gifts, and grants from any source. Such funds shall be transmitted to the state treasurer who shall credit the same to the trust. The department may expend such funds from the trust for the purposes of this article.

(8) (a) Beginning in the 2011-2012 fiscal year and for each fiscal year thereafter, moneys in the trust may be used for costs associated with children enrolled in the medical assistance program, articles 4, 5, and 6 of this title, whose family income is more than one hundred percent but does not exceed one hundred thirty-three percent of the federal poverty line and who would have been eligible for enrollment in the children's basic health plan prior to September 1, 2011.

(b) On July 1, 2016, the state treasurer shall transfer twenty million dollars from the children's basic health plan trust to the primary care provider sustainability fund created in section 25.5-5-418.
C.R.S. § 25.5-1-119 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-119
25.5-1-119. County staff
Status: in_force

25.5-1-119. County staff. The county director, with the approval of the county board, shall appoint such staff as may be necessary as determined by the state department rules to administer medical assistance within the county. The staff shall be appointed and shall serve in accordance with a merit system for the selection, retention, and promotion of county department employees as described in section 26-1-120, C.R.S. The salaries of the staff members shall be fixed in accordance with the rules and salary schedules prescribed by the state department or the department of human services, whichever is appropriate; except that, once a county transfers its county employees to a successor merit system as provided in section 26-1-120, C.R.S., the salaries shall be fixed by the county commissioners.
C.R.S. § 25.5-6-1706 — CO Code / Title 25.5 / Article 6 / Part 17 / Section 25.5-6-1706
25.5-6-1706. Termination of long-term services and supports for member receiving services
Status: in_force

25.5-6-1706. Termination of long-term services and supports for member receiving services. (1) A member receiving long-term services and supports pursuant to this article 6 or article 10 of this title 25.5 must be terminated from long-term services and supports upon a determination, made pursuant to the person-centered support planning process, that the long-term services and supports are no longer necessary. Prior to the effective date of the termination, notification of termination must be given to the member receiving services, the parents or guardian of a minor receiving services, and the person's legal guardian or other legal representative when applicable. A member terminated from services pursuant to this subsection (1) has a right to challenge the termination in accordance with state department rules.

(2) When a member receiving services notifies the case management agency that the member no longer wishes to receive long-term services and supports, the member must be terminated from long-term services and supports unless the member is subject to a petition to impose a legal disability or to remove a legal right, filed pursuant to section 25.5-10-216, or the member has a legal guardian or other legal representative appointed affecting the member's ability to voluntarily terminate long-term services and supports. The parents of a minor who is receiving long-term services and supports and the minor's guardian must be notified of the minor's wish to terminate long-term services and supports, but no minor's long-term services and supports will be terminated without the consent of the minor's parent or legal guardian.
C.R.S. § 25.5-4-402 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-402
25.5-4-402. Providers - hospital reimbursement - hospital review program - rules
Status: repealed

25.5-4-402. Providers - hospital reimbursement - hospital review program - rules. (1) For all licensed or certified hospitals contracting for services under this article and articles 5 and 6 of this title, except those hospitals operated by the department of human services or those hospitals deemed exempt by the state board, the state department shall pay for inpatient hospital services pursuant to a system of prospective payment, generally based on the elements of a diagnosis-related group system. The state department shall develop and administer a system for ensuring appropriate utilization and quality of care provided by those providers who are reimbursed under this section. Subject to available appropriations, the state department may also make supplemental medicaid payments to certain hospitals. The state board shall promulgate rules to provide for the implementation of this section.

(2) (a) A hospital that receives payment under this article and articles 5 and 6 of this title for telemedicine services shall employ its existing quality-of-care protocols and patient confidentiality guidelines to ensure that such services meet the requirements of this article and articles 5 and 6 of this title.

(b) The executive director of the state department shall adopt rules in furtherance of this subsection (2), including, without limitation, rules to:

(I) Ensure the provision of appropriate care to patients;

(II) Prevent fraud and abuse; and

(III) Establish methods and procedures to avoid overuse of telemedicine services.

(3) (a) In addition to the reimbursement rate process described in subsection (1) of this section and subject to adequate funding being made available pursuant to section 25.5-4-402.4, the Colorado healthcare affordability and sustainability enterprise created in section 25.5-4-402.4 (3) shall pay an additional amount based upon performance to those hospitals that provide services that improve health-care outcomes for their patients. The state department shall determine this amount based upon nationally recognized performance measures established in rules adopted by the state board. The state quality standards must be consistent with federal quality standards published by an organization with expertise in health-care quality, including but not limited to, the federal centers for medicare and medicaid services, the agency for healthcare research and quality, or the national quality forum.

(b) The amount of the payments made pursuant to this subsection (3) shall be computed annually. For the first two fiscal years that payments are made pursuant to this subsection (3), the total amount of the payments shall be up to five percent of the total reimbursements made to hospitals in the previous year. For each fiscal year after the first two fiscal years, the total amount of the payments shall be up to seven percent of the total reimbursements made to hospitals in the previous year.

(4) (a) Subject to federal approval, and notwithstanding any other provision of the "Colorado Medical Assistance Act", the state department shall design and implement an evidence-based hospital review program to ensure appropriate utilization of hospital services.

(b) Consistent with federal regulations set forth in 42 CFR 456, the hospital review program may include the following:

(I) Preadmission review;

(II) Continued stay review;

(III) Transfer planning;

(IV) Discharge planning;

(V) Care coordination; and

(VI) Retrospective claims review.

(c) The following factors must be considered in any coverage determinations made pursuant to the hospital review programs:

(I) Information provided, diagnosis determined, and treatment recommended by the treating provider or providers;

(II) Evidence-based clinical coverage criteria and member coverage guidelines as established by the state department;

(III) Nationally recognized utilization and technology assessment guidelines; and

(IV) Industry standard criteria, as appropriate.

(d) (I) The state department shall consult with affected stakeholders prior to implementation of the hospital review program. At a minimum, the state department shall solicit feedback from members, hospitals within Colorado that participate in medicaid, providers participating in the accountable care collaborative pursuant to section 25.5-5-419, and the Colorado healthcare affordability and sustainability enterprise board established in section 25.5-4-402.4 (7). If the state department contracts with a third-party vendor to implement the hospital review program, the state department shall require the vendor to participate in the stakeholder outreach with hospitals required pursuant to this subsection (4)(d)(I).

(II) Prior to implementation of the hospital review program, the state department shall provide an opportunity for hospitals to test connectivity to and workability of any new electronic interface created or implemented as part of this section. The state department shall select a limited group of hospitals to test any new requirements prior to full implementation.

(III) The state department shall provide a report to the joint budget committee by November 1, 2018, on the status of the implementation of the hospital review program. The report must include the comments received as part of the stakeholder process described in subsection (4)(d)(I) of this section and a description of, and any available results from, the testing process described in subsection (4)(d)(II) of this section.

(IV) and (V) Repealed.

(e) The state board shall adopt any rules necessary for the administration and implementation of this section.
C.R.S. § 25.5-1-127 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-127
25.5-1-127. Third-party benefit denials information
Status: in_force

25.5-1-127. Third-party benefit denials information. The state department shall provide information to members who receive benefits under this title 25.5 concerning the members' right to appeal a denial of benefits by a third party and shall post information on the state department's website concerning members' abilities to appeal a third party's denial of benefits, including but not limited to providing a link to information on the insurance commissioner's website regarding appeals.
C.R.S. § 25.5-6-1205 — CO Code / Title 25.5 / Article 6 / Part 12 / Section 25.5-6-1205
25.5-6-1205. Accountability - rate structure - rules
Status: in_force

25.5-6-1205. Accountability - rate structure - rules. (1) The state department shall develop the accountability requirements necessary to safeguard the use of public dollars and to promote effective and efficient service delivery under this part 12.

(2) The state board, by rule, shall set a separate rate structure for in-home support services provided under this part 12.

(3) The state board shall adopt rules as necessary for the implementation and administration of the in-home support services authorized by this part 12. At a minimum, the rules shall include certification of in-home support service agencies and standards of care for the provision of services under this part 12.
C.R.S. § 25.5-6-109 — CO Code / Title 25.5 / Article 6 / Part 1 / Section 25.5-6-109
25.5-6-109. Community long-term care - coordinated care pilot program - federal authorizatio
Status: repealed

25.5-6-109. Community long-term care - coordinated care pilot program - federal authorization - rules - repeal. (Repealed)
C.R.S. § 25.5-6-114 — CO Code / Title 25.5 / Article 6 / Part 1 / Section 25.5-6-114
25.5-6-114. Alternative care facilities - reimbursement programs - legislative declaration -
Status: repealed

25.5-6-114. Alternative care facilities - reimbursement programs - legislative declaration - report - repeal. (Repealed)
C.R.S. § 25.5-4-300.4 — CO Code / Title 25.5 / Article 4 / Part 3 / Section 25.5-4-300.4
25.5-4-300.4. Last resort for payment - legislative intent
Status: in_force

25.5-4-300.4. Last resort for payment - legislative intent. It is the intent of the general assembly that medicaid is the last resort for payment for medically necessary goods and services furnished to members and that all other sources of payment are primary to medical assistance provided by medicaid.
C.R.S. § 25.5-6-1602 — CO Code / Title 25.5 / Article 6 / Part 16 / Section 25.5-6-1602
25.5-6-1602. State department to request increase in reimbursement rate for certain services
Status: in_force

25.5-6-1602. State department to request increase in reimbursement rate for certain services. (1) Not more than ninety days after May 28, 2019, the state department shall request from the federal government an increase of eight and one-tenth percent in the reimbursement rate for the following services delivered to members through the home- and community-based services waivers:

(a) Homemaker;

(b) Homemaker enhanced; and

(c) Personal care.

(2) For the 2019-20 fiscal year, each home care agency shall pay one hundred percent of the funding that results from the rate increase described in subsection (1) of this section as compensation for employees who provide personal care services, homemaker services, and in-home support services to members. This compensation is provided in addition to the rate of compensation that the employee was receiving as of June 30, 2019. For an employee who was hired after June 30, 2019, the home care agency shall use the lowest compensation paid to an employee of similar functions and duties as of June 30, 2019, as the base compensation to which the increase is applied.

(3) Within sixty days after the request described in subsection (1) of this section is approved, each home care agency shall provide written notification to each nonadministrative employee of the agency who provides personal care services, homemaker services, or in-home support services of the compensation they are entitled to pursuant to subsection (2) of this section.
C.R.S. § 25.5-1-124 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-124
25.5-1-124. Early intervention payment system - participation by state department - rules -
Status: repealed

25.5-1-124. Early intervention payment system - participation by state department - rules - definitions. (1) The state department shall participate in the development and implementation of the coordinated system of payment for early intervention services authorized pursuant to part 4 of article 3 of title 26.5 and part C of the federal "Individuals with Disabilities Education Act", 20 U.S.C. sec. 1400 et seq., as amended.

(2) The state department shall ensure that the early intervention services and payments for members of medical assistance pursuant to this title 25.5 are integrated into the coordinated early intervention payment system developed pursuant to part 4 of article 3 of title 26.5. To the extent necessary to achieve the coordinated payment system and coverage of those early intervention services pursuant to this title 25.5, the state department shall amend the state plan for medical assistance or seek the necessary federal authorization, promulgate rules, and modify the billing system for medical assistance to facilitate the coordinated payment system.

(3) The state department shall also make any modifications necessary to the "Children's Basic Health Plan Act", article 8 of this title 25.5, including promulgating rules, to ensure that the children's basic health plan is integrated into the coordinated early intervention payment system developed pursuant to part 4 of article 3 of title 26.5.

(4) Repealed.

(5) (a) As used in this section, unless the context otherwise requires, "early intervention services" means those services defined as early intervention services by the department of early childhood in accordance with section 26.5-3-402 (9) that are determined, through negotiation between the state department and the department of early childhood, to be medically necessary under medical assistance and cost-effective. After negotiating the scope of early intervention services to be covered under medical assistance, the state department and the department of early childhood shall submit to the joint budget committee of the general assembly, as part of each department's annual budget request, a proposal for the scope of coverage of early intervention services under medical assistance, including the anticipated costs of such coverage and whether the payment of such costs through medical assistance is cost-effective.

(b) "Early intervention services" shall not include the following:

(I) Nonemergency medical transportation;

(II) Respite care;

(III) Service coordination, as defined in 34 CFR 303.12 (d)(11); and

(IV) (A) Assistive technology.

(B) The exclusion of assistive technology shall not apply to durable medical equipment that is otherwise covered under the children's basic health plan, as defined in section 25.5-8-103 (2).
C.R.S. § 25.5-4-310 — CO Code / Title 25.5 / Article 4 / Part 3 / Section 25.5-4-310
25.5-4-310. Medicaid false claims report
Status: in_force

25.5-4-310. Medicaid false claims report. (1) Notwithstanding section 24-1-136 (11)(a)(I), on or before January 15, 2012, and on or before each January 15 thereafter, the attorney general shall submit a written report to the health and human services committees of the senate and the house of representatives, or any successor committees, and to the joint budget committee of the general assembly concerning claims brought under the "Colorado Medicaid False Claims Act" during the previous fiscal year. The report shall include, but not be limited to:

(a) The number of actions filed by the attorney general;

(b) The number of actions filed by the attorney general that were completed;

(c) The amount that was recovered in actions filed by the attorney general through settlement or through a judgment and, if known, the amount recovered for damages, penalties, and litigation costs;

(d) The number of actions filed by a person other than the attorney general;

(e) The number of actions filed by a person other than the attorney general that were completed;

(f) The amount that was recovered in actions filed by a person other than the attorney general through settlement or through a judgment and, if known, the amount recovered for damages, penalties, and litigation costs, and the amount recovered by the state and the person; and

(g) The amount expended by the state for investigation, litigation, and all other costs for claims related to the "Colorado Medicaid False Claims Act".
C.R.S. § 25.5-4-414 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-414
25.5-4-414. Providers - physicians - prohibition of certain referrals - definitions
Status: in_force

25.5-4-414. Providers - physicians - prohibition of certain referrals - definitions. (1) As used in this section, unless the context otherwise requires:

(a) "Designated health services" means any of the following services:

(I) Clinical laboratory services;

(II) Physical therapy services;

(III) Occupational therapy services;

(IV) Radiology and other diagnostic services;

(V) Radiation therapy services;

(VI) Durable medical equipment;

(VII) Parenteral or enteral nutrients, equipment, and supplies;

(VIII) Prosthetics, orthotics, and prosthetic devices;

(IX) Home health services;

(X) Outpatient prescription drugs; and

(XI) Inpatient and outpatient hospital services.

(b) "Financial relationship" means an ownership or investment interest in an entity furnishing designated health services or a compensation arrangement between a provider or an immediate family member of the provider and the entity. An ownership or investment interest may be reflected in equity, debt, or other instruments.

(c) "Immediate family member of the provider" means any spouse, natural or adoptive parent, natural or adoptive child, stepparent, stepchild, stepbrother, stepsister, in-law, grandparent, or grandchild of the provider.

(d) "Provider" means:

(I) A doctor of medicine or osteopathy who is licensed to practice medicine pursuant to article 240 of title 12;

(II) A doctor of dental surgery or of dental medicine who is licensed to practice dentistry pursuant to article 220 of title 12;

(III) A doctor of podiatric medicine who is licensed to practice podiatry pursuant to article 290 of title 12;

(IV) A doctor of optometry who is licensed to practice optometry pursuant to article 275 of title 12; or

(V) A chiropractor who is licensed to practice chiropractic pursuant to article 215 of title 12.

(2) (a) Except as otherwise provided in this subsection (2), a provider participating in the medical assistance program under this article and articles 5 and 6 of this title is prohibited from making a referral to an entity for designated health services for which payment may be made under the state's medical assistance program if the provider or an immediate family member of the provider has a financial relationship with the entity.

(b) Paragraph (a) of this subsection (2) shall not apply to any financial relationship that meets the requirements of an exception to the prohibitions established by 42 U.S.C. sec. 1395nn, as amended, or any regulations promulgated thereunder, as amended.

(c) Paragraph (a) of this subsection (2) shall not apply to a financial relationship or referral for designated health services if the financial relationship or referral for designated health services would not violate 42 U.S.C. sec. 1395nn, as amended, and any regulations promulgated thereunder, as amended, if the designated health services were eligible for payment under medicare rather than the "Colorado Medical Assistance Act".

(3) An entity that provides designated health services as a result of a prohibited referral shall not present a claim or bill to any individual, any third-party payor, the state department, or any other entity for the designated health services.

(4) An entity that provides designated health services shall provide to the state department, upon its request and in the form specified by the state department, information concerning the entity's ownership arrangements including:

(a) The items and services provided by the entity;

(b) The names and provider identification numbers of all providers with a financial interest in the entity or whose immediate family members have a financial interest in the entity.

(5) If a provider refers a patient for designated health services in violation of paragraph (a) of subsection (2) of this section or the entity refuses to provide the information required in subsection (4) of this section, the state department may:

(a) Deny any claims for payment from the provider or entity;

(b) Require the provider or entity to refund payments for services;

(c) Refer the matter to the appropriate agency for medical assistance fraud investigation; or

(d) Terminate the provider's or entity's participation in the medical assistance program.
C.R.S. § 25.5-10-217 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-217
25.5-10-217. Conduct of court proceedings
Status: in_force

25.5-10-217. Conduct of court proceedings. All court proceedings arising under section 25.5-10-216 shall be conducted by the district attorney of the county where the proceeding is held or by a qualified attorney acting for the district attorney appointed by the district court for that purpose; except that, in any county or in any city and county having a population exceeding one hundred thousand persons, the proceedings shall be conducted by the county attorney or by a qualified attorney acting for the county attorney appointed by the district court. In any case in which there has been a change of venue to a county other than the county of residence of the respondent or the county in which the proceeding was commenced, the county from which the proceeding was transferred shall either reimburse the county in which the proceeding was held for the reasonable costs incurred in conducting the proceeding or conduct the proceeding itself using its own personnel and resources, including its own district or county attorney, as the case may be.
C.R.S. § 25.5-10-209 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-209
25.5-10-209. Community-centered boards - designation - purchase of services and supports - pe
Status: repealed

25.5-10-209. Community-centered boards - designation - purchase of services and supports - performance audits - Colorado local government audit law - public disclosure of board administration and operations - repeal. (Repealed)
C.R.S. § 25.5-4-102 — CO Code / Title 25.5 / Article 4 / Part 1 / Section 25.5-4-102
25.5-4-102. Legislative declaration
Status: in_force

25.5-4-102. Legislative declaration. It is the purpose of the "Colorado Medical Assistance Act" to promote the public health and welfare of the people of Colorado by providing, in cooperation with the federal government, medical and remedial care and services for individuals and families whose income and resources are insufficient to meet the costs of such necessary services and to assist such individuals and families to attain or retain their capabilities for independence and self-care, as contemplated by the provisions of Title XIX of the social security act. The state of Colorado and its various departments, agencies, and political subdivisions are authorized to promote and achieve these ends by any appropriate lawful means, through cooperation with and the utilization of available resources of the federal government and private individuals and organizations.
C.R.S. § 25.5-1-106 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-106
25.5-1-106. Restructure of health and human services - development of plan - participation o
Status: in_force

25.5-1-106. Restructure of health and human services - development of plan - participation of department required. (Deleted by amendment)
C.R.S. § 25.5-5-321 — CO Code / Title 25.5 / Article 5 / Part 3 / Section 25.5-5-321
25.5-5-321. Telemedicine - home health care - home health telemedicine cash fund - rules - r
Status: repealed

25.5-5-321. Telemedicine - home health care - home health telemedicine cash fund - rules - repeal. (1) On or after August 11, 2010, at-home telemedicine shall be eligible for reimbursement under the state's medical assistance program. The services delivered through telemedicine shall be subject to reimbursement policies promulgated by rule of the state board after consultation with home health-care and home- and community-based services providers. This section also applies to managed care organizations that contract with the state department pursuant to the statewide managed care system, but only to the extent that:

(a) Home health care or home- and community-based services delivered through telemedicine are covered by and reimbursed under the medicaid program; and

(b) Managed care contracts with managed care organizations are amended to add coverage of home health care or home- and community-based services delivered through telemedicine.

(2) (a) The reimbursement rate for home health care or home- and community-based services delivered through telemedicine that are otherwise eligible for reimbursement under the medical assistance program shall be set by rule of the state board and shall be:

(I) In the form of a flat fee in one or more levels, depending on acuity.

(II) (Deleted by amendment, L. 2010, (HB 10-1005), ch. 345, p. 1598, § 1, effective August 11, 2010.)

(b) Any cost savings identified pursuant to this section shall be considered for use in paying for home- and community-based services under part 6 of this article, community-based long-term care, and home health services.

(c) For the first two years after August 11, 2010, gifts, grants, and donations shall be used to implement this section. Gifts, grants, and donations made for this purpose shall be transferred to the home health telemedicine cash fund, which is hereby created in the state treasury. Moneys in the home health telemedicine cash fund shall be appropriated to the state board and used to implement this section. Moneys in the fund shall remain in the fund and not be transferred to the general fund at the end of any fiscal year. After two years or if the moneys in the cash fund are depleted, the department is authorized to go through the normal budget process to continue implementation of this section.

(3) (a) Reimbursement shall not be provided for purchase or lease of telemedicine equipment.

(b) (I) Subsection (3)(a) of this section does not apply to expenditures made pursuant to part 18 of article 6 of this title 25.5.

(II) This subsection (3)(b) is repealed, effective July 1, 2025.

(4) (a) A home health-care or home- and community-based services provider who delivers services through telemedicine shall provide to each patient, before treating that patient through telemedicine for the first time, the following written statements:

(I) That the patient retains the option to refuse the delivery of home health care or home- and community-based services via telemedicine at any time without affecting the patient's right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the patient would otherwise be entitled;

(II) That all applicable confidentiality protections shall apply to the services; and

(III) That the patient shall have access to all medical information resulting from the telemedicine services as provided by applicable law for patient access to his or her medical records.

(b) The provisions of paragraph (a) of this subsection (4) shall not apply in an emergency.

(5) Nothing in this section shall be construed to:

(a) Alter the scope of practice of any home health-care or home- and community-based services provider; or

(b) Authorize the delivery of home health care or home- and community-based services in a setting or manner not otherwise authorized by law.
C.R.S. § 25.5-10-215 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-215
25.5-10-215. Compliance with local government zoning regulations - notice to local government
Status: in_force

25.5-10-215. Compliance with local government zoning regulations - notice to local governments - provisional licensure. (1) The state department shall require any community residential home seeking licensure pursuant to section 25.5-10-214 to comply with any applicable zoning regulations of the municipality, city and county, or county where the home is situated. Failure to comply with applicable zoning regulations shall constitute grounds for the denial of a license to a home; except that nothing in this section shall be construed to supersede the provisions of sections 30-28-115 (2), 31-23-301 (4), and 31-23-303 (2), C.R.S.

(2) The state department shall ensure that timely written notice is provided to the municipality, city and county, or county where a community residential home is situated, including the address of the home and the population and number of persons to be served by the home, when any of the following occurs:

(a) An application for a license to operate a community residential home pursuant to section 25.5-10-214 is made;

(b) A license is granted to a community residential home pursuant to section 25.5-10-214;

(c) A change in the license of a community residential home occurs; or

(d) The license of a community residential home is revoked or otherwise terminated for any reason.

(3) In the event of a zoning or other delay or dispute between a community residential home and the municipality, city and county, or county where the home is situated, the state department may grant a provisional license to the home for up to one hundred twenty days pending resolution of the delay or dispute.
C.R.S. § 25.5-10-208 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-208
25.5-10-208. Service agencies and case management agencies - money - rules
Status: repealed

25.5-10-208. Service agencies and case management agencies - money - rules. (1) A service agency and a case management agency shall comply with the requirements set forth in this article 10 and the rules promulgated thereunder.

(2) The state board shall promulgate rules to implement the purchase of long-term services and supports from a service agency, case management agency, or family caregiver. The rules must include, but need not be limited to:

(a) Terms and conditions necessary to promote the effective delivery of services and supports, including those services and supports delivered by a family caregiver;

(b) Procedures for obtaining an annual audit of case management agencies and service agencies to provide financial information deemed necessary by the state department to establish costs of long-term services and supports and to ensure proper management of money received pursuant to section 25.5-10-206;

(c) Repealed.

(d) Specification of which long-term services and supports are to be reimbursed by the state department and secondarily by the case management agency, the source of reimbursement, actual long-term service or support costs, incentives, and program service objectives that affect reimbursement;

(e) The methods of coordinating the purchase of services and supports, including but not limited to service and support coordination, with other federal, state, and local programs that provide funding for authorized services and supports; and

(f) Criteria for and limitations on any rates that case management agencies charge to service agencies based upon a percentage of the rates that service agencies charge for long-term services and supports.

(3) Any incorporated service agency that is registered in Colorado as a foreign corporation shall organize a local advisory board consisting of persons who reside within the defined service area. The advisory board shall be representative of the community at large and persons receiving services and their families.

(4) Upon a determination by the executive director that services or supports have not been provided in accordance with the program or financial administration standards specified in this article 10 and the rules promulgated thereunder, the executive director may reduce, suspend, or withhold payment to a case management agency or service agency under contract with a case management agency, or service agency from which the state department purchased long-term services or supports directly. When the executive director decides to reduce, suspend, or withhold payment, the executive director shall specify the reasons therefor and the actions that are necessary to bring the case management agency or service agency into compliance.

(5) Nothing in this article or in any rules promulgated pursuant thereto and no actions taken by the executive director pursuant to this article shall be construed to affect the obtaining of funds from local authorities, including those funds obtained from a mill levy assessed by a county or municipality for the purpose of purchasing services or supports for persons with intellectual and developmental disabilities, or to require that such funds from local authorities be used to supplant state or federal funds available for purchasing services and supports for persons with developmental disabilities.
C.R.S. § 25.5-4-104 — CO Code / Title 25.5 / Article 4 / Part 1 / Section 25.5-4-104
25.5-4-104. State medical assistance program - single state agency
Status: in_force

25.5-4-104. State medical assistance program - single state agency. (1) The state department, by rules, shall establish a program of medical assistance to provide necessary medical care for the categorically needy. The state department is designated as the single state agency to administer the medical assistance program in accordance with Title XIX of the federal "Social Security Act" and this article 4 and articles 5 and 6 of this title 25.5. The program is not required to furnish to members under sixty-five years of age the benefits that are provided to members sixty-five years of age and over under Title XVIII of the federal "Social Security Act", but the medical assistance program must otherwise be uniform to the extent required by Title XIX of the federal "Social Security Act".

(2) The state department may review any decision of a county department and may consider any application upon which a decision has not been made by the county department within a reasonable time to determine the propriety of the action or failure to take timely action on an application for medical assistance. The state department shall conduct any additional investigation the state department deems necessary. After giving the county department an opportunity to rebut the state department's findings or conclusions that the action or delay in taking action was a violation of or contrary to state department rules, the state department shall make a decision whether to grant medical benefits and the amount of medical benefits pursuant to this article 4 and articles 5 and 6 of this title 25.5 and the rules of the state department. Applicants or members affected by the state department's decisions, upon request, must be given reasonable notice and opportunity for a fair hearing by the state department.
C.R.S. § 25.5-5-204 — CO Code / Title 25.5 / Article 5 / Part 2 / Section 25.5-5-204
25.5-5-204. Presumptive eligibility - pregnant person - children - long-term care - state pl
Status: in_force

25.5-5-204. Presumptive eligibility - pregnant person - children - long-term care - state plan. (1) For purposes of this section, "presumptive eligibility" means the self-declaration of income, assets, and status in order to promptly receive medical assistance services prior to the verification of income, assets, and status.

(2) (a) A pregnant person is presumptively eligible for the medical assistance program and shall receive services specified by federal law only if the person declares all pertinent information relating to the criteria of income, assets, and, only if necessary to administer reimbursement for services, status.

(b) (Deleted by amendment, L. 2022.)

(2.5) A child less than nineteen years of age is presumptively eligible for the medical assistance program and shall receive services specified by federal law only if a parent or legal guardian of the child declares all pertinent information relating to the criteria of income, assets, and, only if necessary to administer reimbursement for services, status of the child's family.

(2.7) (a) The state department is authorized to seek federal authorization to allow a person who is in need of long-term services and supports, as defined in section 25.5-6-1702 (10), to be presumptively eligible for the medical assistance program pursuant to this article 5 and articles 4 and 6 of this title 25.5.

(b) [Editor's note: This version of subsection (2.7)(b) is effective until January 1, 2026.] If the state department receives federal authorization pursuant to subsection (2.7)(a) of this section and sufficient spending authority, a person in need of long-term services and supports shall be presumptively eligible for the medical assistance program if the person or the person's legal representative declares all pertinent information relating to the criteria of income, assets, and immigration status. The person shall be assessed for the appropriate level of care pursuant to section 25.5-6-1704. If required due to limitations of federal authorization or spending authority, the state department may implement this subsection (2.7)(b) as a pilot program rather than statewide.

(b) [Editor's note: This version of subsection (2.7)(b) is effective January 1, 2026.] If the state department receives federal authorization pursuant to subsection (2.7)(a) of this section and sufficient spending authority, a person in need of long-term services and supports shall be presumptively eligible for the medical assistance program if the person or the person's legal representative declares all pertinent information relating to the criteria of income, assets, immigration status, and any other information that may be required pursuant to the federal authorization. If required due to limitations of federal authorization or spending authority, the state department may implement this subsection (2.7)(b) as a pilot program rather than statewide.

(c) The state department shall make any necessary changes to the state plan waivers for home- and community-based service programs and any other federal authorizations that are authorized pursuant to this article 5 and articles 4 and 6 of this title 25.5 to comply with this subsection (2.7).

(d) If it is determined that a member was not eligible for medical benefits after the member had been determined to be eligible based upon presumptive eligibility, the state department shall not pursue recovery from a county department for the cost of medical services provided to the member, and the county department shall not be responsible for any federal error rate sanctions resulting from such determination.

(3) The state department shall make any necessary changes to the state plan to comply with this section.
C.R.S. § 25.5-5-319 — CO Code / Title 25.5 / Article 5 / Part 3 / Section 25.5-5-319
25.5-5-319. Family planning pilot program - rules - federal waiver - repeal
Status: repealed

25.5-5-319. Family planning pilot program - rules - federal waiver - repeal. (1) There is hereby established a family planning pilot program for the provision of family planning services to categorically eligible individuals who are at or below a percentage of the federal poverty line established pursuant to the federal waiver sought pursuant to subsection (2) of this section. The state board shall promulgate rules setting forth the family planning services to be provided under the family planning pilot program.

(2) The executive director of the state department, in consultation with the department of public health and environment, shall seek a federal waiver that is cost-neutral to the state general fund for the implementation of the family planning pilot program established pursuant to this section such that ten percent of the family planning services provided to low-income families pursuant to the program as described in subsection (1) of this section would be funded with state general fund moneys and ninety percent would be funded with federal matching funds. In the federal waiver, the executive director shall not seek authority to waive or disregard the provisions of 42 U.S.C. sec. 1396a (a)(23)(B).

(3) (a) Upon issuance of the federal waiver sought pursuant to subsection (2) of this section, the departments of health care policy and financing and public health and environment shall seek the necessary appropriation of general funds through the normal budgetary process for the implementation of this act.

(b) The executive director of the state department is authorized to accept and expend on behalf of the state any funds, grants, gifts, and donations from any private or public source for the purpose of implementing the family planning pilot program established in this section; except that no gift, grant, donation, or funds shall be accepted if the conditions attached thereto require the expenditure thereof in a manner contrary to law.

(4) The executive director of the state department, or such executive director's designee, shall prepare a written report for the members of the general assembly concerning the findings of the department based upon the family planning pilot program. Such report shall be provided to the members of the general assembly not more than three years after commencement of the program. The report shall address the number of individuals served, the type of services provided, the cost of the program, and such other information as the executive director deems appropriate.

(5) The implementation of this section is conditioned upon the issuance of any necessary waiver by the federal government and available appropriations pursuant to paragraph (a) of subsection (3) of this section. The provisions of this section shall be implemented to the extent authorized by federal waiver. The pilot program established by this section shall continue for five years from the receipt of the federal waiver or for so long as specified in the federal waiver. The executive director of the state department shall provide written notice to the revisor of statutes of the final termination date of the waiver, and this section shall be repealed, effective July 1 five years after the issuance of the federal waiver or July 1 in the year in which the waiver is terminated, whichever occurs first.
C.R.S. § 25.5-5-326 — CO Code / Title 25.5 / Article 5 / Part 3 / Section 25.5-5-326
25.5-5-326. Access to clinical trials - definitions
Status: in_force

25.5-5-326. Access to clinical trials - definitions. (1) As used in this section, unless the context otherwise requires:

(a) "Approved clinical trial" means a phase I, II, III, or IV clinical trial involving the prevention, detection, diagnosis, or treatment of a life-threatening or debilitating disease or condition if any one of the following conditions apply:

(I) The clinical trial is conducted under an investigational new drug application or an investigational device exemption reviewed by the federal food and drug administration, or is exempted from review by the federal food and drug administration; or

(II) The clinical trial is approved or funded by:

(A) The national institutes of health;

(B) The centers for disease control and prevention;

(C) The agency for health care research and quality;

(D) The federal centers for medicare and medicaid services;

(E) A cooperative group or center of any of the entities described in subsections (1)(a)(II)(A) to (1)(a)(II)(D) of this section, the federal department of defense, or the federal department of veterans affairs;

(F) A qualified nongovernmental research entity identified in guidelines issued by the national institutes of health for center support grants; or

(G) The federal department of veterans affairs, the federal department of defense, or the federal department of energy, provided that review and approval of the clinical trial occurs through a system of peer review that is comparable to the peer review of clinical trials performed by the national institutes of health, including an unbiased review of the highest scientific standards by qualified individuals who have no interest in the outcome of the review.

(b) "Life-threatening or debilitating disease or condition" means a disease or condition from which the likelihood of death is probable, or the disease or condition is progressive or significantly debilitating, unless the course of the disease or condition is interrupted.

(c) "Qualified individual" means an individual who is eligible for and enrolled in the state medical assistance program and who a treating physician determines has a life-threatening or debilitating disease or condition and meets the selection criteria for the approved clinical trial.

(d) (I) "Routine costs" means medically necessary items and services that are included under the medical assistance program for a medical assistance member, to the extent that the provision of the items or services to the individual outside the course of such participation would otherwise be covered under the medical assistance program, without regard to whether the member is enrolled in a clinical trial. For medical assistance members participating in an approved clinical trial, "routine costs" include medically necessary items and services that are not otherwise excluded pursuant to subsection (1)(d)(II)(D) of this section, relating to the detection and treatment of complications arising from the medical assistance member's medical care, including complications relating to participation in the clinical trial, to the extent that the provision of the items or services to the individual outside the course of such participation would otherwise be included under the medical assistance program.

(II) "Routine costs" do not include:

(A) The investigational item, device, or service itself;

(B) Items and services provided solely to satisfy the data collection and analysis needs of the clinical trial;

(C) Items, drugs, or services customarily provided free of charge to any qualified individual enrolled in the clinical trial; or

(D) Items, drugs, or services that the clinical trial is required to provide.

(2) The medical assistance program established pursuant to this article 5 and articles 4 and 6 of this title 25.5 must include coverage and payment for the routine costs associated with participation in an approved clinical trial for a qualified individual.
C.R.S. § 25.5-4-406 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-406
25.5-4-406. Rate setting - medicaid residential treatment service providers - monitoring and
Status: in_force

25.5-4-406. Rate setting - medicaid residential treatment service providers - monitoring and auditing - report. (1) The state department shall approve a rate-setting process consistent with medicaid requirements for providers of medicaid residential treatment services in the state of Colorado as developed by the department of human services. The rate-setting process developed pursuant to this section may include, but shall not be limited to:

(a) A range for reimbursement that represents a base-treatment rate for serving a child who is subject to out-of-home placement due to dependency and neglect, a child placed in a residential child care facility pursuant to the "Children and Youth Mental Health Treatment Act", article 67 of title 27, or a child who has been adjudicated a delinquent, which includes a defined service package to meet the needs of the child;

(b) A request for proposal to contract for specialized service needs of a child, including but not limited to: Substance-abuse treatment services; sex offender services; and services for the developmentally disabled; and

(c) Negotiated incentives for achieving outcomes for the child as defined by the state department, counties, and providers.

(2) The medicaid rate-setting process approved by the state department shall include a two- or three-year implementation timeline with implementation beginning in state fiscal year 2008-09.

(3) The state department and the department of human services, in consultation with the representatives of the counties and the provider community, shall review the rate-setting process every two years and shall submit any changes to the joint budget committee of the general assembly.
C.R.S. § 25.5-1-601 — CO Code / Title 25.5 / Article 1 / Part 6 / Section 25.5-1-601
25.5-1-601. Legislative declaration
Status: in_force

25.5-1-601. Legislative declaration. (1) The general assembly hereby finds and declares that:

(a) Physicians engaged in family medicine are in critically short supply in this state;

(b) Because of the distribution of such physicians, many rural and urban areas of the state are underserved;

(c) A significant portion of the state population is medically underserved because of indigency;

(d) Family physicians provide health care to all segments of the population;

(e) The provision of more competent family physicians is a public purpose of great importance; and

(f) The creation of the commission on family medicine is a desirable, necessary, and cost-effective means of addressing the needs described in this subsection (1).
C.R.S. § 25.5-5-325 — CO Code / Title 25.5 / Article 5 / Part 3 / Section 25.5-5-325
25.5-5-325. Partial hospitalization and residential and inpatient substance use disorder tre
Status: in_force

25.5-5-325. Partial hospitalization and residential and inpatient substance use disorder treatment - medical detoxification services - federal approval - performance review report. (1) 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 partial hospitalization and residential and inpatient substance use disorder treatment and medical detoxification services. Participation in partial hospitalization and the residential and inpatient substance use disorder treatment and medical detoxification services benefit is limited to persons who meet nationally recognized, evidence-based level of care criteria for partial hospitalization or residential and inpatient substance use disorder treatment and medical detoxification services. The benefit must serve persons with substance use disorders, including those with co-occurring mental health disorders. All levels of nationally recognized, evidence-based levels of care for partial hospitalization and residential and inpatient substance use disorder treatment and medical detoxification services must be included in the benefit.

(2) (a) No later than October 1, 2018, the state department shall seek federal authorization to provide residential and inpatient substance use disorder treatment and medical detoxification services with full federal financial participation. Residential and inpatient substance use disorder treatment and medical detoxification services shall not take effect until federal approval has been obtained.

(b) Prior to seeking federal approval pursuant to subsection (2)(a) of this section, the state department shall seek input from relevant stakeholders, including existing providers of substance use disorder treatment and medical detoxification services and behavioral health administrative services organizations. The state department shall seek input and involve stakeholders in decisions regarding:

(I) The coordination of benefits with behavioral health administrative services organizations and the department of human services;

(II) The most appropriate entity for administration of the benefit;

(III) The provision of wraparound services needed during treatment and the provision of required services following treatment that may not be covered through the medical assistance program;

(IV) The authorization process for approval of services; and

(V) The development of a reimbursement rate methodology to ensure sustainability that considers a provider's cost of providing care, including lower-volume providers in rural areas.

(2.5) No later than July 1, 2026, the state department shall seek federal authorization to provide partial hospitalization for substance use disorder treatment with full federal financial participation. Partial hospitalization for substance use disorder treatment shall not take effect until federal approval has been obtained.

(3) (a) No later than January 15, 2022, the state department shall prepare and submit a performance review report to the joint budget committee and to the joint health and human services committee, or any successor committees, concerning the residential and inpatient substance use disorder treatment pursuant to this section, including, at a minimum:

(I) The number of persons who received services pursuant to this section and the service provided;

(II) The length of time that services were provided;

(III) The location where services were provided;

(IV) The effectiveness of the services provided, including the rate of relapse to substance use disorder following treatment; and

(V) Any other information as determined by the state department that is relevant to the benefit.

(b) After considering the state department's performance review report, the general assembly may enact legislation modifying or repealing the benefit.
C.R.S. § 25.5-6-401 — CO Code / Title 25.5 / Article 6 / Part 4 / Section 25.5-6-401
25.5-6-401. Short title
Status: in_force

25.5-6-401. Short title. This part 4 shall be known and may be cited as the "Home- and Community-based Services for Persons with Developmental Disabilities Act".
C.R.S. § 25.5-5-407 — CO Code / Title 25.5 / Article 5 / Part 4 / Section 25.5-5-407
25.5-5-407. State department recommendations - primary care physician program
Status: repealed

25.5-5-407. State department recommendations - primary care physician program. (Repealed)
C.R.S. § 25.5-1-113 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-113
25.5-1-113. Federal authorization - repeal
Status: in_force

25.5-1-113. Federal authorization - repeal. (Deleted by amendment)
C.R.S. § 25.5-4-203 — CO Code / Title 25.5 / Article 4 / Part 2 / Section 25.5-4-203
25.5-4-203. Advisory council established
Status: in_force

25.5-4-203. Advisory council established. (1) There is created the state medical assistance and services advisory council, referred to in this article 4 as the "advisory council", consisting of sixteen members, as follows:

(a) The executive director of the state department and the executive director of the department of public health and environment, the executive directors' designees, or the executive directors' successors in function, as ex officio members; and

(b) Fourteen members, appointed by the governor and chosen by the governor to represent the various areas of medical services and the public as follows:

(I) Two members who are doctors of medicine licensed in this state;

(II) One member who is a doctor of osteopathy licensed in this state;

(III) One member who is a dentist licensed in this state;

(IV) One member who is an optometrist licensed in this state;

(V) One member who is an owner or operator of a licensed nursing facility in this state;

(VI) One member who represents licensed hospitals in this state;

(VII) One member who is a pharmacist licensed in this state;

(VIII) One member who is a professional nurse licensed in this state;

(IX) One member who has provided home health-care services for three years;

(X) Three members who are not directly associated with the areas of medical services to represent the public; and

(XI) One member who may represent any other area of medical services not specifically enumerated but shall not be limited thereto.

(2) Advisory council members serve at the pleasure of the governor and receive no compensation but are entitled to reimbursement for actual and necessary expenses. The advisory council shall advise the state department on the provision of health and medical care services to members of medical assistance.
C.R.S. § 25.5-6-301 — CO Code / Title 25.5 / Article 6 / Part 3 / Section 25.5-6-301
25.5-6-301. Short title
Status: in_force

25.5-6-301. Short title. This part 3 shall be known and may be cited as the "Home- and Community-based Services for the Elderly, Blind, and Disabled Act".
C.R.S. § 25.5-8-112 — CO Code / Title 25.5 / Article 8 / Section 25.5-8-112
25.5-8-112. Authority to the department to apply for federal waivers
Status: in_force

25.5-8-112. Authority to the department to apply for federal waivers. The department is hereby authorized and required to apply for any federal waivers necessary to implement the purposes of this article.
C.R.S. § 25.5-4-107 — CO Code / Title 25.5 / Article 4 / Part 1 / Section 25.5-4-107
25.5-4-107. Retaliation definition
Status: in_force

25.5-4-107. Retaliation definition. (1) For purposes of any rules promulgated by the state department or state board and any action taken by the state department against any person, "retaliation" means taking any of the following actions against a member or someone acting on behalf of a member after the member or someone acting on behalf of the member files a complaint concerning services provided or not provided to the member:

(a) Indicating to a member that the member cannot have an advocate, family member, or other authorized representative assist the member; or

(b) (I) An adverse action that negatively affects a member's level of eligibility for or receipt of services received at the time of the complaint without verification of a change in the member's income, resources, or health-care needs that justifies the adverse action.

(II) An adverse action must not be taken against a member after a complaint has been filed until the member is notified of the proposed action, informed of the reason for the proposed action, and provided an opportunity to appeal the proposed action.

(2) "Retaliation" does not include instances when a member is not eligible for a service or program or when a provider documents a problem with a member and shares the documentation with the member or a third party prior to the member filing a complaint.
C.R.S. § 25.5-6-412 — CO Code / Title 25.5 / Article 6 / Part 4 / Section 25.5-6-412
25.5-6-412. Cross-system response for behavioral health crises pilot program - legislative d
Status: repealed

25.5-6-412. Cross-system response for behavioral health crises pilot program - legislative declaration - creation - criteria - recommendations - fund - repeal. (Repealed)
C.R.S. § 25.5-6-313 — CO Code / Title 25.5 / Article 6 / Part 3 / Section 25.5-6-313
25.5-6-313. Rules - federal authorization
Status: in_force

25.5-6-313. Rules - federal authorization. (1) Pursuant to article 4 of title 24, C.R.S., the state board shall adopt rules for the administration of this part 3.

(1.5) The rules adopted by the state board pursuant to subsection (1) of this section shall include the following provisions concerning adult day care facilities:

(a) A definition of a restricted environment and a restrictive egress alert device;

(b) Parameters governing how the restrictive egress alert device shall be used and tested and the staff roles regarding the use and oversight of the device; and

(c) Parameters governing a restricted environment, including but not limited to staffing and training requirements; appropriateness of placement; assessment; participant's rights; records and reporting requirements; building requirements including grounds and fire safety; restrictive egress alert systems and devices; fencing or other enclosures; and the application process to offer a restricted environment.

(2) The state department is authorized to seek any necessary federal authorization to implement the provisions of this part 3.
C.R.S. § 25.5-6-408 — CO Code / Title 25.5 / Article 6 / Part 4 / Section 25.5-6-408
25.5-6-408. Eligibility - fees
Status: in_force

25.5-6-408. Eligibility - fees. (1) Subject to the availability of federal financial participation, services shall be provided to eligible persons pursuant to this part 4.

(2) Any eligible person who accepts and receives services pursuant to this part 4 shall pay to the state department, or to an agent designated by the state department, an amount determined pursuant to federal regulations construing the federal "Social Security Act", as amended, concerning the application of patient income to the cost of services.
C.R.S. § 25.5-1-108 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-108
25.5-1-108. Executive director - rules
Status: in_force

25.5-1-108. Executive director - rules. (1) The executive director shall have authority to promulgate rules in connection with the policies and procedures governing the administration of the department including, but not limited to, rules concerning the following:

(a) Matters of internal administration of the department, including organization, staffing, records, reports, systems, and procedures;

(b) Fiscal and personnel administration for the department;

(c) Accounting and fiscal reporting policies and procedures for disbursement of federal funds, contingency funds, and distribution of available appropriations;

(d) Such other rules relating to those functions the executive director is required to carry out pursuant to the provisions of this title.

(2) Nothing in this section shall be construed to affect any specific statutory provision granting rule-making authority in relation to a specific program to the executive director.
C.R.S. § 25.5-5-422 — CO Code / Title 25.5 / Article 5 / Part 4 / Section 25.5-5-422
25.5-5-422. Medication-assisted treatment - limitations on MCEs - definition
Status: in_force

25.5-5-422. Medication-assisted treatment - limitations on MCEs - definition. (1) As used in this section, "FDA" means the food and drug administration in the United States department of health and human services.

(2) Notwithstanding any provision of law to the contrary, each MCE that provides prescription drug benefits or methadone administration for the treatment of substance use disorders shall:

(a) Not impose any prior authorization requirements on any prescription medication approved by the FDA for the treatment of substance use disorders, regardless of the dosage amount;

(b) Not impose any step therapy requirements as a prerequisite to authorizing coverage for a prescription medication approved by the FDA for the treatment of substance use disorders;

(c) Not exclude coverage for any prescription medication approved by the FDA for the treatment of substance use disorders and any associated counseling or wraparound services solely on the grounds that the medications and services were court ordered; and

(d) Set the reimbursement rate for take-home methadone treatment and office-administered methadone treatment at the same rate.
C.R.S. § 25.5-4-408 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-408
25.5-4-408. Services provided by licensed psychologists - cost containment program
Status: in_force

25.5-4-408. Services provided by licensed psychologists - cost containment program. (1) Working in conjunction with licensed psychologists in the state, the state board shall promulgate rules to establish and implement mechanisms for containing the costs of services provided by licensed psychologists under the medical assistance programs established pursuant to this article and articles 5 and 6 of this title. The cost containment mechanism shall ensure that the costs to the medical assistance program will result in no increase in the total cost of the program solely as a result of the reimbursement for services of licensed psychologists pursuant to section 25.5-4-407. The cost containment mechanisms may include the following:

(a) Limiting the number of days a licensed psychologist may be reimbursed per patient for inpatient hospitalization, partial hospitalization, and outpatient visits without an order for continued treatment from a doctor of medicine or osteopathy;

(b) Limiting the number of hours a licensed psychologist may be reimbursed for diagnostic testing and evaluation per patient per year;

(c) Provision of group therapy when needed or appropriate;

(d) Provision of licensed psychologists' services from a pool of those licensed psychologists requesting to be included in such pool;

(e) Provision of a licensed psychologist's services through the use of telemedicine pursuant to the provisions of section 25.5-5-320.
C.R.S. § 25.5-6-1707 — CO Code / Title 25.5 / Article 6 / Part 17 / Section 25.5-6-1707
25.5-6-1707. Records and confidentiality of information
Status: in_force

25.5-6-1707. Records and confidentiality of information. (1) A record for each member receiving services must be diligently maintained by the case management agency or the entity. The record must include, but not be limited to, information pertaining to the determination of eligibility for services and the person-centered support plan. The record is not a public record for purposes of the "Colorado Open Records Act", part 2 of article 72 of title 24.

(2) Except as otherwise provided by law, all information obtained and any records prepared in the course of determining eligibility or providing long-term services and supports pursuant to this article 6 or article 10 of this title 25.5 are confidential and subject to the evidentiary privileges established by law. The disclosure of this information and these records in any manner is permitted only:

(a) To the applicant or member receiving services, to the parents of a minor receiving services, to the member's legal guardian, or to any person authorized by the member receiving services;

(b) In communications between qualified professional personnel, including the board of directors or governing body of the case management agency and service agencies providing services to the member, to the extent necessary for the acquisition, provision, oversight, or referral of long-term services and supports;

(c) To the extent necessary to make claims for aid, insurance, or medical assistance to which a member receiving services may be entitled, or to access long-term services and supports pursuant to the person-centered support plan;

(d) For the purposes of evaluation, gathering statistics, or research when no identifying information concerning a person or family is disclosed. Identifying information is information which could reasonably be expected to identify a specific person and includes, but is not limited to, name, address, telephone number, social security number, medicaid number, household number, and photograph.

(e) To the court when necessary to implement the provisions of this article 6 or article 10 of this title 25.5;

(f) To persons authorized by a court order issued after a hearing, notice of which was given to the member, parents or legal guardian, where appropriate, and the custodian of the information;

(g) To safeguard the health and safety of an at-risk member by coordinating appropriate services and medical supports;

(h) To the agency designated pursuant to 45 CFR 1326.20 as the protection and advocacy system for Colorado when:

(I) The protection and advocacy system receives a complaint from or on behalf of a member receiving services; and

(II) The person does not have a legal guardian or the state or the designee of the state is the legal guardian of the person; and

(i) To the state department or the state department's designees as deemed necessary by the executive director to fulfill the duties prescribed by this article 6 or article 10 of this title 25.5.

(3) Nothing in this section limits a member receiving services access to the member's records.

(4) Nothing in this section interferes with the protections afforded to a person under the federal "Health Insurance Portability and Accountability Act of 1996", 42 U.S.C. sec. 1320d, and the federal "Family Educational Rights and Privacy Act of 1974", 20 U.S.C. sec. 1232g.
C.R.S. § 25.5-4-401.2 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-401.2
25.5-4-401.2. Performance-based payments - reporting
Status: repealed

25.5-4-401.2. Performance-based payments - reporting. (1) To improve health outcomes and lower health-care costs, the state department may develop payments to providers that are based on quantifiable performance or measures of quality of care. These performance-based payments may include, but are not limited to, payments to:

(a) Primary care providers;

(b) Federally qualified health centers;

(c) Providers of long-term care services and supports; and

(d) Behavioral health providers, including, but not limited to:

(I) Repealed.

(II) Behavioral health safety net providers, as defined in section 27-50-101; and

(III) Entities contracted with the state department to administer the statewide system of community behavioral health care established in section 25.5-5-402.

(2) (a) Prior to implementing performance-based payments in the medicaid program pursuant to this article 4 and articles 5 and 6 of this title 25.5, including performance-based payments set forth in this section, the state department shall submit to the joint budget committee:

(I) (A) Evidence that the performance-based payments are designed to achieve budget savings; or

(B) A budget request for costs associated with the performance-based payments;

(II) The estimated performance-based payments compared to total reimbursements for the affected service; and

(III) A description of the stakeholder engagement process for developing the performance-based payments, including the participants in the process and a summary of the stakeholder feedback, and the state department's response to stakeholder feedback.

(b) The information required pursuant to subsection (2)(a) of this section must be provided on or before November 1 for performance-based payments that will take effect in the following fiscal year unless the state department includes with its submission an explanation of the need for faster implementation of the payment. If faster implementation is requested, the state department shall provide the information at least three months prior to the implementation of the performance-based payments unless compliance with federal law necessitates shorter notice.

(3) On or before November 1, 2017, and on or before November 1 each year thereafter, the state department shall submit a report to the joint budget committee, the public health care and human services committee of the house of representatives, and the health and human services committee of the senate, or any successor committees, describing rules adopted by the state board and contract provisions approved by the federal centers for medicare and medicaid services in the preceding calendar year that authorize payments to providers based on performance. Notwithstanding the provisions of section 24-1-136 (11)(a)(I), the report required pursuant to this subsection (3) continues indefinitely. The report must include, at a minimum:

(a) A description of performance-based payments included in state board rules, including which performance standards are targeted with each performance-based payment;

(b) A description of the goals and objectives of the performance-based payments, and how those goals and objectives align with other quality improvement initiatives;

(c) A summary of the research-based evidence for the performance-based payments, to the extent such evidence is available;

(d) A summary of the anticipated impact and clinical and nonclinical outcomes of implementing the performance-based payments;

(e) A description of how the impact or outcomes will be evaluated;

(f) An explanation of steps taken by the state department to limit the administrative burden on providers;

(g) A summary of the stakeholder engagement process with respect to each performance-based payment, including major concerns raised through the stakeholder process and how those concerns were remediated;

(h) When available, evaluation results for performance-based payments that were implemented in prior years; and

(i) A description of proposed modifications to current performance-based payments.
C.R.S. § 25.5-10-227 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-227
25.5-10-227. Right to personal property
Status: in_force

25.5-10-227. Right to personal property. (1) Each person receiving services has the right to the possession and use of such person's own clothing and personal effects. If the service agency holds any of such person's personal effects for any reason, such retention shall be promptly recorded in such person's record and the reason for retention shall also be recorded.

(2) Upon the request of a person receiving services, a service agency may hold money or funds belonging to the person receiving services, received by such person, or received by the service agency for such person. All such money or funds shall be held by the service agency as trustee for the person receiving services. Upon request, an accounting shall be rendered by the service agency.

(3) Upon request, a person receiving services is entitled to receive reasonable amounts of such person's money or funds held in trust.
C.R.S. § 25.5-10-223 — CO Code / Title 25.5 / Article 10 / Part 2 / Section 25.5-10-223
25.5-10-223. Rights to communications and visits
Status: in_force

25.5-10-223. Rights to communications and visits. (1) Each person receiving services has the right to communicate freely and privately with others of the person's own choosing.

(2) Each person receiving services has the right to receive and send sealed, unopened correspondence. No such person's incoming or outgoing correspondence shall be opened, delayed, held, or censored by any person.

(3) Each person receiving services shall have the right to receive and send packages. No such person's outgoing packages shall be opened, delayed, held, or censored by any person.

(4) Each person receiving services must have reasonable access to telephones, both to make and to receive calls in privacy, and must be afforded reasonable and frequent opportunities to meet with visitors.

(5) All service agencies shall ensure that persons receiving services have suitable opportunities for interaction with persons of their choice. Nothing in this section will limit the protections provided under article 3.1 of title 26, C.R.S.
C.R.S. § 25.5-4-429 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-429
25.5-4-429. Hospital and provider billing requirements - description of service provided - r
Status: in_force

25.5-4-429. Hospital and provider billing requirements - description of service provided - rules. Beginning July 1, 2024, any patient bill for services rendered must follow industry standard billing practices, including, at a minimum, the date of service, the patient's name, the provider's name, a description of the services provided, and the charges for each service.
C.R.S. § 25.5-4-433 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-433
25.5-4-433. Rural hospital cash fund - creation - definition
Status: in_force

25.5-4-433. Rural hospital cash fund - creation - definition. (1) The rural hospital cash fund is created in the state treasury and is referred to in this section as the "fund". The fund consists of money credited to the fund and any other money that the general assembly may appropriate or transfer to the fund.

(2) The state treasurer shall credit all interest and income derived from the deposit and investment of money in the fund to the fund.

(3) Money in the fund is continuously appropriated to the department of health care policy and financing for the purpose of distributing money in equal amounts to rural hospitals.

(4) On July 1, 2024, the state treasurer shall transfer one million seven hundred forty-two thousand twenty-nine dollars from the general fund to the fund.

(5) As used in this section, "rural 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 a hospital, and that is located in a county with a population of fewer than fifty thousand residents or in 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.
C.R.S. § 25.5-4-402.7 — CO Code / Title 25.5 / Article 4 / Part 4 / Section 25.5-4-402.7
25.5-4-402.7. Unexpended hospital provider fee cash fund - creation - transfer from hospital p
Status: repealed

25.5-4-402.7. Unexpended hospital provider fee cash fund - creation - transfer from hospital provider fee cash fund - use of fund - repeal. (Repealed)
C.R.S. § 25.5-2-103 — CO Code / Title 25.5 / Article 2 / Section 25.5-2-103
25.5-2-103. Reproductive health-care program - report - rules - definitions
Status: repealed

25.5-2-103. Reproductive health-care program - report - rules - definitions. (1) As used in this section, unless the context otherwise requires:

(a) Repealed.

(b) "Eligible individual" means an individual with reproductive capacity, regardless of gender, who would be eligible to enroll in the medical assistance program, as described in section 25.5-4-103 (13), but is not eligible due solely to the individual's immigration status, and who is not eligible for, or declines to enroll in, state medical assistance, as described in section 25.5-2-104.

(c) "FDA" means the federal food and drug administration.

(d) "Participant" means an eligible individual enrolled in the reproductive health-care program.

(e) "Pharmacist" means a licensed pharmacist who has entered into a collaborative pharmacy practice agreement pursuant to section 12-280-602 to prescribe and dispense hormonal contraceptive patches and oral hormonal contraceptives.

(f) "Provider" has the same meaning as set forth in section 25.5-4-103 (19)(a).

(g) "Reproductive health-care services" means family planning services, as defined in section 25.5-4-412 (2)(b), and family-planning-related services, as defined in section 25.5-4-412 (2)(a).

(2) On and after July 1, 2022, the state department shall administer a reproductive health-care program, referred to in this section as the "program", that provides reproductive health-care services to participants.

(3) Upon the participant's initial and follow-up visits to the participant's provider, and unless the participant requests a shorter period of time, the program shall comply with the federal centers for disease control and prevention's selected practice recommendations for contraceptive use by ensuring the participant is offered at least a one-year supply of either:

(a) The requested contraceptive drug, device, or product or one or more therapeutic equivalents of the requested drug, device, or product, if the therapeutic equivalent is available and approved by the FDA; or

(b) An alternative contraceptive drug, device, or product, if a contraceptive drug, device, or product is deemed medically inadvisable by the participant's provider.

(4) A participant's choice of a contraceptive drug, device, or product must not be infringed upon and must not require prior authorization, step therapy, or other utilization control techniques for medically appropriate contraceptive drugs, devices, or products approved by the FDA.

(5) The state board shall adopt rules as necessary to implement this section, including rules specifying the manner in which eligible individuals will be notified about the program and the manner in which eligible individuals may enroll in the program.

(5.5) To the extent practicable, the state department shall ensure that eligible individuals seeking to participate in the program are able to apply for and enroll in the program through their local county office, a state medical assistance program site, an online application, or any other mechanism that is available to applicants for the state medical assistance program.

(6) The state department shall provide reproductive health-care services to participants without imposing any cost-sharing requirements.

(7) Beginning in state fiscal year 2023-24, the state department shall analyze and report the cost-effectiveness of the program 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. At a minimum, the report must include:

(a) The total number of eligible individuals;

(b) The total number of participants enrolled in the program, disaggregated by race, ethnicity, gender identity, and income level;

(c) The cost of providing reproductive health-care services to participants;

(d) The participants' preferred method of contraceptive methods; and

(e) The cost savings realized due to avoided unintended pregnancies, including avoided hospital costs.
C.R.S. § 25.5-6-603 — CO Code / Title 25.5 / Article 6 / Part 6 / Section 25.5-6-603
25.5-6-603. Definitions
Status: in_force

25.5-6-603. Definitions. As used in this part 6, unless the context otherwise requires:

(1) "Eligible person" means a person:

(a) Who has a primary diagnosis of a major mental health disorder, as such term is defined in the diagnostic and statistical manual of mental disorders used by the mental health profession, and includes schizophrenic, paranoid, major affective, and schizoaffective disorders, and atypical psychosis, but does not include dementia diseases and related disabilities;

(b) Who is in need of the level of care available in a nursing facility;

(c) Who is categorically eligible for medical assistance, or whose gross income does not exceed three hundred percent of the current federal supplemental security income benefit level, and whose resources do not exceed the limit established for individuals receiving a mandatory minimum state supplementation of supplemental security income benefits or, in the case of a person who is married, do not exceed the amount authorized in section 25.5-6-101.
C.R.S. § 25.5-8-109.3 — CO Code / Title 25.5 / Article 8 / Section 25.5-8-109.3
25.5-8-109.3. Health services initiatives
Status: in_force

25.5-8-109.3. Health services initiatives. (1) To the extent federal financial participation is available, the department shall design and implement health service initiatives pursuant to section 2105(a)(1)(D)(ii) of the federal "Social Security Act", as amended, to provide funding for continuous enrollment for the twelve-month postpartum period for a person who is enrolled in health-care coverage pursuant to section 25.5-5-201 (6) or 25.5-8-109 (7).

(2) To the extent additional federal financial participation is available, the department shall establish a stakeholder process in collaboration with department staff to determine additional priorities and budget allocations that draw down at least fifty percent of the remaining health services initiative funds to expand access to perinatal and postpartum supports. The department shall report on the established priorities and budget allocations and the ways in which they are inclusive of stakeholder input during the department's 2024 presentation to the joint budget committee of the general assembly and in the department's 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". In conducting the stakeholder process, the department shall:

(a) Engage directly with impacted individuals, service providers, advocacy organizations, and individuals working in or representing communities who are diverse with regard to race, ethnicity, immigration status, age, ability, sexual orientation, gender identity, or geographic region of the state and who are affected by higher rates of health disparities and inequities;

(b) Publicize, conduct, and report outcomes of stakeholder meetings in, at a minimum, English and Spanish;

(c) Include opportunities for participation in the stakeholder process outside of regular work hours;

(d) Conduct a minimum of five stakeholder meetings and conduct additional meetings focused on hearing input from individual constituencies listed in subsection (2)(a) of this section;

(e) Take into consideration research and information from reports issued by the maternal mortality review committee, as required by section 25-52-104 (6);

(f) Take into consideration data from the health survey for birthing parents to inform stakeholder decision-making; and

(g) Consider initiatives to reduce diaper need, expand access to group-based prenatal and pediatric care models, and expand home visitation programs, including voluntary newborn nurse visitation programs that are universally offered to all families in a given community and provide at least one nurse visit within the first three months of life.

(3) (a) The department shall seek any necessary federal approvals to obtain federal financial participation in implementing subsection (1) of this section.

(b) To the extent allowable, the department shall maximize federal financial participation in implementing this section.
C.R.S. § 25.5-1-107 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-107
25.5-1-107. Final agency action - administrative law judge - authority of executive director
Status: in_force

25.5-1-107. Final agency action - administrative law judge - authority of executive director. (1) The executive director may appoint one or more individuals to serve as administrative law judges for the state department pursuant to section 24-4-105 and pursuant to part 10 of article 30 of title 24 subject to appropriations made to the department of personnel. Except as provided in subsection (2) of this section, hearings conducted by the administrative law judge are considered initial decisions of the state department, and the executive director or the executive director's designee shall review the initial decisions. If exceptions to the initial decision are filed pursuant to section 24-4-105 (14)(a)(I), the review must be conducted in accordance with section 24-4-105 (15). In the absence of any exception filed pursuant to section 24-4-105 (14)(a)(I), the executive director or the executive director's designee shall review the initial decision in accordance with a procedure adopted by the state board. The procedure must be consistent with federal mandates concerning the single state agency requirement. Review by the executive director or the executive director's designee in accordance with section 24-4-105 (15) or the procedure adopted by the state board pursuant to this section constitutes final agency action. The administrative law judge may conduct hearings on appeals from decisions of county departments of human or social services brought by members of and applicants for medical assistance and welfare that are required by law in order for the state to qualify for federal funds, and the administrative law judge may conduct other hearings for the state department. Notice of any hearing must be served at least ten days prior to the hearing.

(2) Hearings initiated by a licensed or certified provider of services shall be conducted by an administrative law judge for the state department and shall be considered final agency action and subject to judicial review in accordance with the provisions of section 24-4-106, C.R.S., for any party, including the state department, which shall be considered a person for such purposes.
C.R.S. § 25.5-3-503 — CO Code / Title 25.5 / Article 3 / Part 5 / Section 25.5-3-503
25.5-3-503. Health-care discounts on services not eligible for Colorado indigent care progra
Status: in_force

25.5-3-503. Health-care discounts on services not eligible for Colorado indigent care program reimbursement - definition. (1) Beginning September 1, 2022, if a patient is screened pursuant to section 25.5-3-502 and is determined to be a qualified patient, a health-care facility and a licensed health-care professional shall, for emergency hospital and other health-care services:

(a) Limit the amounts charged to not more than the discounted rate established in state department rule pursuant to section 25.5-3-505 (2)(j);

(b) Collect amounts charged, not including amounts owed by third-party payers, in monthly installments such that the patient is not paying more than four percent of the patient's monthly household income on a bill from a health-care facility, not paying more than two percent of the patient's monthly household income on a bill from each licensed health-care professional, and not paying more than six percent of the patient's household income on a comprehensive bill containing all health-care facility and licensed health-care professional charges; and

(c) After a cumulative thirty-six months of payments, consider the patient's bill paid in full and permanently cease any and all collection activities on any balance that remains unpaid.

(2) A health-care facility shall not:

(a) Deny discounted care on the basis that the patient has not applied for any public benefits program, unless during the initial screening the patient is determined to be presumptively eligible for the state medical assistance program; or

(b) Adopt or maintain any policies that result in the denial of admission or treatment of a patient because the patient lacks health insurance coverage, may qualify for discounted care, requires extended or long-term treatment, or has an unpaid medical bill.

(3) The licensed health-care professional who provides services to a patient pursuant to this part 5 is responsible for billing the patient for those services, unless the services are billed on a comprehensive bill issued by a health-care facility.

(4) For the purposes of this part 5, "emergency hospital and other health-care services" does not include primary care provided in a clinic located in a designated rural or frontier county that offers a sliding-fee scale as approved by the state department.
C.R.S. § 25.5-6-209 — CO Code / Title 25.5 / Article 6 / Part 2 / Section 25.5-6-209
25.5-6-209. Establishment of nursing facility provider demonstration of need - criteria - ru
Status: in_force

25.5-6-209. Establishment of nursing facility provider demonstration of need - criteria - rules. (1) The state department, in making any medicaid certification determination, shall encourage an appropriate allocation of public health-care resources and the development of alternative or substitute methods of delivering health-care services so that adequate long-term care services are made reasonably available to every qualified member within the state at the appropriate level of care, at the lowest reasonable aggregate cost, and in the least restrictive setting. Medicaid certification determinations shall be made in accordance with Olmstead v. L.C., 527 U.S. 581 (1999).

(2) The state department shall develop, analyze, and enforce a demonstration of need to determine the viability of and required need for each new nursing facility provider seeking medicaid certification. The requirement does not apply to a nursing facility provider certified prior to June 30, 2021.

(3) In order to determine a valid demonstration of need, the state department shall, at a minimum, consider:

(a) State demography office data illustrating the present or impending need within the requesting nursing facility's geographic area;

(b) Quality and performance data of the requesting nursing facility or associated nursing facilities;

(c) Business continuity and solvency information of the requesting nursing facility or associated nursing facilities;

(d) Input from the department of public health and environment; the department of local affairs; the department of regulatory agencies; the department of labor and employment; and any local governments, including cities and counties; and

(e) Measurable innovative practices of the requesting nursing facility.

(4) No later than June 30, 2022, the state board shall promulgate rules pursuant to the "State Administrative Procedure Act", article 4 of title 24, addressing the establishment of criteria to be used in determining a nursing facility provider's medicaid certification. The state board shall publicly consider and gather input on the demonstration of need criteria prior to promulgating rules. The state department shall consider input from, at a minimum:

(a) Disability advocacy organizations;

(b) Urban nursing facility providers;

(c) Rural nursing facility providers;

(d) Aging and older adult advocacy organizations; and

(e) Nursing facility trade organizations.
C.R.S. § 25.5-5-338 — CO Code / Title 25.5 / Article 5 / Part 3 / Section 25.5-5-338
25.5-5-338. Continuous glucose monitors - coverage - federal authorization - definition
Status: in_force

25.5-5-338. Continuous glucose monitors - coverage - federal authorization - definition. (1) As used in this section, unless the context otherwise requires, "continuous glucose monitor" means an instrument or a device designed for the purpose of aiding in the treatment of diabetes by measuring glucose levels on demand or at set intervals through a small electronic sensor that slightly penetrates an individual's skin when applied and that is designed to remain in place and active for at least seven days.

(2) (a) Beginning November 1, 2025, the state department shall provide coverage for a continuous glucose monitor and related supplies to members under the medicaid medical and pharmacy benefit.

(b) Coverage criteria must align with the current glucose monitor local coverage determination standards issued by the centers for medicare and medicaid that are used to determine coverage for medicare-eligible individuals, including individuals with gestational diabetes not being treated with insulin.

(3) Coverage pursuant to this section includes the cost of any necessary repairs or replacement parts for the continuous glucose monitor.

(4) The state department may seek any federal authorization necessary to implement this section.

(5) The state department is authorized to receive and expend gifts, grants, and donations from individuals, private organizations, foundations, or any governmental unit; except that no gift, grant, or donation may be accepted by the state department if it is subject to a condition that is inconsistent with this section or any other law of this state.
C.R.S. § 25.5-6-1401 — CO Code / Title 25.5 / Article 6 / Part 14 / Section 25.5-6-1401
25.5-6-1401. Legislative declaration
Status: in_force

25.5-6-1401. Legislative declaration. The general assembly hereby declares its support for the full employment of people with disabilities. It is the general assembly's intent to enact this part 14 for the purpose of allowing an individual with disabilities to purchase medicaid coverage that will enable the individual to maintain employment without losing his or her medicaid benefits.
C.R.S. § 25.5-3-201 — CO Code / Title 25.5 / Article 3 / Part 2 / Section 25.5-3-201
25.5-3-201. Short title
Status: repealed

25.5-3-201. Short title. (Repealed)
C.R.S. § 25.5-1-118 — CO Code / Title 25.5 / Article 1 / Part 1 / Section 25.5-1-118
25.5-1-118. Duties of county departments
Status: in_force

25.5-1-118. Duties of county departments. (1) The county departments or other state designated agencies, where applicable, shall serve as agents of the state department and shall be charged with the administration of medical assistance and related activities in the respective counties in accordance with the rules of the state department.

(2) The county departments or other state designated agencies, where applicable, shall report to the state department at such times and in such manner and form as the state department may from time to time direct.

(3) The county department or other state designated agencies, where applicable, in each county shall submit quarterly and annually to the board of county commissioners a budget containing an estimate and supporting data setting forth the amount of money needed to carry out the provisions of this title.
C.R.S. § 25.5-6-1208 — CO Code / Title 25.5 / Article 6 / Part 12 / Section 25.5-6-1208
25.5-6-1208. Conditional repeal of part
Status: repealed

25.5-6-1208. Conditional repeal of part. (Repealed)