reglab/housing_qa huggingface dataset:
CO Code § 25.5-4-405 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 4 - Providers - Reimbursement|§ 25.5-4-405. Mental Health Managed Care Service Providers - Requirements

  Each contract between the state department and a managed care organization providing mental health services to a recipient under the medical assistance program shall comply with all federal requirements, including but not limited to:   Ensuring that a recipient with complex or multiple needs who requires mental health services shall have access to mental health professionals with appropriate training and credentials and shall provide the recipient with such services in collaboration with the recipient's other providers;    Informing each recipient of his or her right to and the process for appeal upon notification of denial, termination, or reduction of a requested service; and    Administering initial stabilization treatment for a recipient and transferring the recipient for appropriate continued services. (1.5) Each contract between the state department and a managed care organization providing mental health services to a recipient under the medical assistance program shall allow for the use of telemedicine pursuant to the provisions of section 25.5-5-320 .       For mental health managed care recipients, the state department shall have a patient representative program for recipient grievances that complies with all federal requirements and that shall:   Be posted in a conspicuous place at each location at which mental health services are provided;    Allow for a patient representative to serve as a liaison between the recipient and the provider;    Describe the qualifications for a patient representative;    Outline the responsibilities of a patient representative;    Describe the authority of a patient representative; and    Establish a method by which each recipient is informed of the patient representative program and how a patient representative may be contacted.        History. Source: L. 2006: Entire article added with relocations, p. 1844, § 7, effective July 1. L. 2008: (1.5) added, p. 111, § 1, effective August 5.    Editor's note:   This section is similar to former § 26-4-409.5 as it existed prior to 2006.
CO Code § 25.5-4-406 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 4 - Providers - Reimbursement|§ 25.5-4-406. Rate Setting - Medicaid Residential Treatment Service Providers - Monitoring and Auditing - Report

  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 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;    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    Negotiated incentives for achieving outcomes for the child as defined by the state department, counties, and providers.       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.    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.     History. Source: L. 2006: Entire article added with relocations, p. 1845, § 7, effective July 1. L. 2007: (1)(a), (2), and (3) amended, p. 618, § 2, effective August 3. L. 2010: (1)(a) amended, (SB 10-175), ch. 188, p. 800, § 66, effective April 29. L. 2018: (1)(a) amended, (HB 18-1094), ch. 343, p. 2044, § 10, effective June 30.
CO Code § 25.5-4-407 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 4 - Providers - Reimbursement|§ 25.5-4-407. Services by Licensed Psychologists Without a Doctor's Referral

 The executive director of the state department may authorize the providing of services of licensed psychologists without the requirement that the services be referred by a doctor of medicine or a doctor of osteopathy, but such services shall be subject to the cost containment program specified under section 25.5-4-408 . The executive director may except from the authorization those services the director determines to be necessary for the purpose of promoting the primary care physician program.   History. Source: L. 2006: Entire article added with relocations, p. 1846, § 7, effective July 1.    Editor's note:   This section is similar to former § 26-4-412 as it existed prior to 2006.
CO Code § 25.5-4-408 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 4 - Providers - Reimbursement|§ 25.5-4-408. Services Provided by Licensed Psychologists - Cost Containment Program

  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:   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;    Limiting the number of hours a licensed psychologist may be reimbursed for diagnostic testing and evaluation per patient per year;    Provision of group therapy when needed or appropriate;    Provision of licensed psychologists' services from a pool of those licensed psychologists requesting to be included in such pool;    Provision of a licensed psychologist's services through the use of telemedicine pursuant to the provisions of section 25.5-5-320.        History. Source: L. 2006: Entire article added with relocations, p. 1846, § 7, effective July 1. L. 2008: (1)(e) added, p. 111, § 2, effective August 5.    Editor's note:   This section is similar to former § 26-4-516 as it existed prior to 2006.
CO Code § 25.5-4-409 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 4 - Providers - Reimbursement|§ 25.5-4-409. Authorization of Services - Nurse Anesthetists - Advanced Practice Nurses

  When services by a certified registered nurse anesthetist are provided pursuant to an order by a physician in accordance with this article 4, articles 5 and 6 of this title 25.5, and section 12-255-104 (10), the executive director of the state department shall authorize reimbursement for said services. Payment for such services shall be made directly to the nurse anesthetist, if requested by the nurse anesthetist; except that this section shall not apply to nurse anesthetists when acting within the scope of their employment as salaried employees of public or private institutions or physicians.    When services by an advanced practice nurse registered pursuant to section 12-255-111 are provided in accordance with this article 4 and articles 5 and 6 of this title 25.5, the executive director of the state department shall authorize reimbursement for said services. Payment for the services shall be made directly to the advanced practice nurse, if requested by the advanced practice nurse; except that this section shall not apply to advanced practice nurses when acting within the scope of their employment as salaried employees of public or private institutions or physicians.     History. Source: L. 2006: Entire article added with relocations, p. 1846, § 7, effective July 1. L. 2008: (2) amended, p. 138, § 1, effective July 1. L. 2019: Entire section amended,(HB 19-1172), ch. 136, p. 1707, § 178, effective October 1.    Editor's note:   This section is similar to former § 26-4-413 as it existed prior to 2006.   ANNOTATION   The governor's attestation under federal law that allows states to opt out of the requirement that certified nurse anesthetists receive physician supervision while administering anesthesia in order to receive Medicare reimbursement is not a binding interpretation of the supervision provisions of the state Nurse Practice Act. The attestation has the single effect of exempting certified nurse anesthetists from the federal supervision requirement without jeopardizing their Medicare reimbursements. Colo. Med. Soc'y v. Hickenlooper, 2015 CO 41, 349 P.3d 1133 .
CO Code § 25.5-4-410 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 4 - Providers - Reimbursement|§ 25.5-4-410. Services of Audiologists and Speech Pathologists Without Supervision

  When medical or diagnostic services by an audiologist or speech pathologist are provided pursuant to an order by a physician in accordance with this article and articles 5 and 6 of this title, the executive director of the state department shall authorize reimbursement for said services. For the purposes of this section, “audiologist” or “speech pathologist” means an individual who meets the requirements set forth in the federal “Social Security Act”, as amended, or any federal regulations adopted pursuant thereto, for participating providers of audiology or speech pathology services.    Nothing in this section shall be construed as expanding the provision of services available as a part of the medical assistance program established pursuant to this article and articles 5 and 6 of this title. For the purposes of making payments to audiologists or speech pathologists pursuant to this section, the state board shall establish rules implementing this section. The rules promulgated pursuant to this subsection (2) 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 an audiologist or speech pathologist pursuant to this section.    Payments for services included in this section shall be made directly to the audiologist or speech pathologist, if requested by the audiologist or speech pathologist; except that this section shall not apply to audiologists or speech pathologists when acting within the scope of their employment as salaried employees of public or private institutions or physicians.     History. Source: L. 2006: Entire article added with relocations, p. 1847, § 7, effective July 1.    Editor's note:   This section is similar to former § 26-4-414 as it existed prior to 2006.
CO Code § 25.5-4-411 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 4 - Providers - Reimbursement|§ 25.5-4-411. Authorization of Services Provided by Dental Hygienists

  When dental hygiene services are provided to children by a licensed dental hygienist who is providing dental hygiene services pursuant to section 12-220-503 without the supervision of a licensed dentist, the executive director of the state department shall authorize reimbursement for said services, subject to the requirements of this section. Payment for the services shall be made directly to the licensed dental hygienist, if requested by the licensed dental hygienist; except that this section shall not apply to licensed dental hygienists when acting within the scope of their employment as salaried employees of public or private institutions, physicians, or dentists.    For each child provided dental hygiene services pursuant to this section, the dental hygienist shall attempt to identify a dentist participating in medicaid for the child.     History. Source: L. 2006: Entire article added with relocations, p. 1847, § 7, effective July 1. L. 2019: (1) amended,(HB 19-1172), ch. 136, p. 1707, § 179, effective October 1. L. 2020: (1) amended,(HB 20-1056), ch. 64, p. 263, § 9, effective September 14.    Editor's note:   This section is similar to former § 26-4-414.3 as it existed prior to 2006.
CO Code § 25.5-4-413 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 4 - Providers - Reimbursement|§ 25.5-4-413. Certain Providers to Inform Patients of Rights Concerning Advance Medical Directives

  On and after November 5, 1991, with regard to any service rendered on and after said date, each hospital, nursing care facility, home health agency, hospice program, and health maintenance organization participating in the state medical assistance program or providing medical assistance pursuant to parts 3 to 12 of article 6 of this title shall provide written information to all adult patients of such providers concerning patients' rights under state law to make medical treatment decisions, including the right to accept or refuse any medical or surgical treatment and the right to formulate advance directives regarding said decisions. As used in this section, “advance directives” includes any written or oral instructions recognized under state law concerning the making of medical treatment decisions on behalf of or the provision of medical care for the person who provided the instructions in the event such person becomes incapacitated. Advance directives include, but are not limited to, medical durable powers of attorney, durable powers of attorney, or living wills.    Providers listed in subsection (1) of this section shall provide educational programs for staff and the community concerning advance directives and shall maintain written policies detailing methods for safeguarding patients' rights concerning medical treatment decisions, including documenting in the patient's medical or patient record whether the patient has executed, amended, or revoked an advance directive. No provider shall condition the provision of services or otherwise discriminate against a patient on the basis of whether the patient has executed an advance directive.     History. Source: L. 2006: Entire article added with relocations, p. 1848, § 7, effective July 1.    Editor's note:   This section is similar to former § 26-4-403.5 as it existed prior to 2006.
CO Code § 25.5-4-416 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 4 - Providers - Reimbursement|§ 25.5-4-416. Providers - Medical Equipment and Supplies - Requirements

  As used in this section, unless the context otherwise requires, “provider” means a person or entity that delivers disposable medical supplies or durable medical equipment products or services directly to a recipient.    On and after January 1, 2007, the state board rules for the payment for disposable medical supplies and durable medical equipment, including but not limited to prosthetic and orthotic devices, shall prohibit a provider from being reimbursed unless the provider:     Has one or more physical locations within the state of Colorado or within fifty miles of a border of Colorado with a street address, a local business telephone number, an inventory, and a sufficient staff to service or repair products; except that the requirements of this paragraph (a) shall not apply to durable medical equipment or disposable medical supplies that are medically necessary and cannot be purchased from a provider meeting the requirements of this paragraph (a); (a) (I) Has one or more physical locations within the state of Colorado or within fifty miles of a border of Colorado with a street address, a local business telephone number, an inventory, and a sufficient staff to service or repair products; except that the requirements of this paragraph (a) shall not apply to durable medical equipment or disposable medical supplies that are medically necessary and cannot be purchased from a provider meeting the requirements of this paragraph (a);    Complies with all state and local licensing, insurance, and regulatory requirements for operating the provider's business;    Is responsible for the delivery of and instructing the recipient on the proper use of the equipment; and    Provides repairs, replacements, or adjustments to the provider's products pursuant to rules of the state board; or       Contracts with a provider who meets the criteria established in paragraph (a) of this subsection (2).       The provisions of this section shall apply to fee-for-service and primary care physician program recipients.      History. Source: L. 2006: Entire section added, p. 525, § 1, effective August 7.    Editor's note:   This section was originally numbered as § 26-4-410.7 in House Bill 06-1299. Section 2 of the act provided for the renumbering and relocation of § 26-4-410.7 to this section. (See L. 2006, p. 526 .)
CO Code § 25.5-4-423 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 4 - Providers - Reimbursement|§ 25.5-4-423. Targets for Investments in Primary Care

 The state department shall adopt appropriate targets for investments in primary care to support value-based health-care delivery in alignment with the affordability standards developed in accordance with section 10-16-107 (3.5). The state department shall consider the recommendations of the primary care payment reform collaborative created in section 10-16-150 . Targets established under this section do not apply in the case of a nonprofit, nongovernmental health maintenance organization with respect to managed care plans that provide a majority of covered professional services through a single contracted medical group.   History. Source: L. 2019: Entire section added,(HB 19-1233), ch. 194, p. 2123, § 7, effective May 16.    Cross references:   For the legislative declaration in HB 19-1233, see section 1 of chapter 194, Session Laws of Colorado 2019.
CO Code § 25.5-4-425 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 4 - Providers - Reimbursement|§ 25.5-4-425. Providers - Health-Care Services Related to Labor and Delivery - Reimbursement

  The state department shall reimburse all eligible providers that provide health-care services related to labor and delivery within the scope of the provider's practice in a manner that:   Promotes high-quality, cost-effective, and evidence-based care;    Promotes high-value, evidence-based payment models; and    Prevents risk in subsequent pregnancies.        History. Source: L. 2021: Entire section added, (SB 21-194), ch. 434, p. 2871, § 6, effective September 7.
CO Code § 25.5-4-503 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 4 - Colorado Medical Assistance Act - General Medical Assistance|Part 5 - State Plan Amendments - Waiver Authority|§ 25.5-4-503. Waiver Applications - Authorization

 The state department is authorized to apply for health insurance flexibility and accountability waivers that will enable the state to add more flexibility to Colorado's medicaid program and that will result in a cost-effective method of providing health-care services to Coloradans.   History. Source: L. 2006: Entire article added with relocations, p. 1853, § 7, effective July 1.    Editor's note:   This section is similar to former § 25.5-1-111 as it existed prior to 2006.
CO Code § 25.5-5-104 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 1 - Mandatory Provisions|§ 25.5-5-104. Qualified Medicare Beneficiaries

 Qualified medicare beneficiaries are medicare-eligible individuals with income and resources at a level which qualifies them as eligible under section 301 of Title III of the federal “Medicare Catastrophic Coverage Act of 1988”, as amended, or subsequent amending federal legislation. For purposes of this article and articles 4 and 6 of this title, such individuals shall be referred to as “qualified medicare beneficiaries”. The state department is hereby designated as the single state agency to administer benefits available to qualified medicare beneficiaries in accordance with Title XIX and this article and articles 4 and 6 of this title. Such benefits are limited to medicare cost-sharing expenses as determined by the federal government. Accordingly, the state department shall not be required to provide qualified medicare beneficiaries the entire range of services set forth in section 25.5-5-102 .   History. Source: L. 2006: Entire article added with relocations, p. 1857, § 7, effective July 1.    Editor's note:   This section is similar to former § 26-4-510 as it existed prior to 2006.   Cross references:   For provisions of the federal “Medicare Catastrophic Coverage Act of 1988” referenced in this section, see section 301 of Pub.L. 100-360, codified at 42 U.S.C. sec. 1396a et seq.   ANNOTATION   Law reviews. For article, “The Impacts of Trusts on Public Benefits for Disabled Persons”, see 46 Colo. Law. 43 (Nov. 2017).
CO Code § 25.5-5-105 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 1 - Mandatory Provisions|§ 25.5-5-105. Qualified Disabled and Working Individuals

 Qualified disabled and working individuals are persons with income and resources and disability status, as determined by the social security administration, which qualify them as “qualified disabled and working individuals” under sections 6012 and 6408 of the federal “Omnibus Budget Reconciliation Act of 1989”, or subsequent amending federal legislation. The state department is hereby designated as the single state agency to administer benefits available to qualified disabled and working individuals. Such benefits are limited to medicare cost-sharing expenses as determined by the federal government. Accordingly, the state department shall not be required to provide qualified disabled and working individuals the entire range of services set forth in section 25.5-5-102 .   History. Source: L. 2006: Entire article added with relocations, p. 1858, § 7, effective July 1.    Editor's note:   This section is similar to former § 26-4-511 as it existed prior to 2006.   Cross references:   For provisions of the federal “Omnibus Budget Reconciliation Act of 1989” referenced in this section, see sections 6012 and 6408 of Pub.L. 101-239, codified at 42 U.S.C. secs. 1395i and 1396a.