reglab/housing_qa huggingface dataset:
CO Code § 25.5-5-500.3 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 5 - Prescription Drugs|§ 25.5-5-500.3. Authorization to Bill Third Party

 As a condition of doing business in the state, each provider is deemed to authorize the state department, or an independent contractor retained by the state department, to bill a third party, as defined in section (2)(g)(II) , on behalf of the provider if the third party is determined to be liable to pay for care pursuant to sections 25.5-4-209 and 25.5-4-300.4 .   History. Source: L. 2010: Entire section added,(SB 10-167), ch. 296, p. 1379, § 9, effective May 26.    Cross references:   For the legislative declaration in SB 10-167, see section 1 of chapter 296, Session Laws of Colorado 2010.
CO Code § 25.5-5-501 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 5 - Prescription Drugs|§ 25.5-5-501. Providers - Drug Reimbursement

     As to drugs for which payment is made, the state board's rules for payment must include the requirement that the generic equivalent of a brand-name drug be prescribed if the generic equivalent is a therapeutic equivalent to the brand-name drug, except when reimbursement to the state for a brand-name drug makes the brand-name drug less expensive than the cost of the generic equivalent. The state department shall grant an exception to this requirement if the patient has been stabilized on a medication and the treating physician, or a pharmacist with the concurrence of the treating physician, is of the opinion that a transition to the generic equivalent of the brand-name drug would be unacceptably disruptive. The requirements of this subsection (1) do not apply to medications for the treatment of behavioral or mental health disorders, cancer, epilepsy, or human immunodeficiency virus and acquired immune deficiency syndrome.    The provisions of this subsection (1) shall apply to fee-for-service and primary care physician program recipients.       It is the general assembly's intent that requiring the use of a generic equivalent of a brand-name drug will produce savings within the state's medicaid program. The state department, therefore, is authorized to use savings in the medical services premiums appropriations to fund the administrative review process required by subsection (1) of this section.     History. Source: L. 2006: Entire article added with relocations, p. 1904, § 7, effective July 1. L. 2013: (1)(a) amended,(HB 13-1266), ch. 217, p. 992, § 63, effective May 13. L. 2017: (1)(a) amended,(SB 17-242), ch. 263, p. 1329, § 205, effective May 25.    Editor's note:   This section is similar to former § 26-4-406 as it existed prior to 2006.   Cross references:   For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.
CO Code § 25.5-5-502 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 5 - Prescription Drugs|§ 25.5-5-502. Unused Medications - Reuse - Rules - Definition

  As used in this section, unless the context otherwise requires, “medication” means prescription medication that is not a controlled substance.    A pharmacist participating in the medical assistance program may accept unused medication from a licensed facility, as defined in section 12-280-135 (1)(b), or a licensed health-care provider for the purpose of dispensing the medication to another person. A pharmacist shall reimburse the state department for the cost of medications that the state department has paid to the pharmacist if medications are returned to a pharmacist and the medications are available to be dispensed to another person. Medications shall only be available to be dispensed to another person under this section if the medications are:   Liquid and the vial is still sealed and properly stored;    Individually packaged and the packaging has not been damaged; or    In the original, unopened, sealed, and tamper-evident unit dose packaging.       Medication dispensed pursuant to this section shall bear an expiration date that is later than six months after the date the drug was donated.    Any savings realized through reimbursements received pursuant to subsection (2) of this section shall fund the administration of this section.    The state board, in consultation with the state board of pharmacy, shall adopt rules for the implementation of this section.     History. Source: L. 2006: Entire article added with relocations, p. 1904, § 7, effective July 1. L. 2012: IP(2) amended,(HB 12-1311), ch. 281, p. 1621, § 76, effective July 1. L. 2019: IP(2) amended,(HB 19-1172), ch. 136, p. 1710, § 186, effective October 1. L. 2021: (4) amended,(SB 21-266), ch. 423, p. 2803, § 24, effective July 2.    Editor's note:   This section is similar to former § 26-4-406.3 as it existed prior to 2006.
CO Code § 25.5-5-503 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 5 - Prescription Drugs|§ 25.5-5-503. Prescription Drug Benefits - Authorization - Dual-Eligible Participation

  The state department is authorized to ensure the participation of Colorado medical assistance recipients, who are also eligible for medicare, in any federal prescription drug benefit enacted for medicare recipients.    Prescribed drugs shall not be a covered benefit under the medical assistance program for a recipient who is eligible for a prescription drug benefit program under medicare; except that, if a prescribed drug is not a covered Part D drug as defined in the “Medicare Prescription Drug, Improvement, and Modernization Act of 2003”, Pub.L. 108-173, the prescribed drug may be a covered benefit if it is otherwise covered under the medical assistance program and federal financial participation is available.     History. Source: L. 2006: Entire article added with relocations, p. 1905, § 7, effective July 1. L. 2007: (2) amended, p. 1631, § 1, effective July 1.    Editor's note:   This section is similar to former § 26-4-406.5 as it existed prior to 2006.   Cross references:   For additional information on the federal “Medicare Prescription Drug, Improvement, and Modernization Act of 2003”, see Pub.L. 108-173.
CO Code § 25.5-5-504 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 5 - Prescription Drugs|§ 25.5-5-504. Providers of Pharmaceutical Services

  Consistent with the provisions of section 25.5-4-401 (1), and consistent with subsections (2) and (3) of this section, and subject to available appropriations, no provider of pharmaceutical services who meets the conditions imposed by this article and articles 4 and 6 of this title and who complies with the terms and conditions established by the state department and contracting health maintenance organizations and prepaid health plans shall be excluded from contracting for the provision of pharmaceutical services to recipients authorized in this article and articles 4 and 6 of this title.    This provision shall not apply to a health maintenance organization or prepaid health plan that enrolls less than forty percent of all the resident medicaid recipients in any county with over one thousand medicaid recipients.    The state board shall establish specifications in rules in order to provide criteria to health maintenance organizations and prepaid health plans which ensure the accessibility and quality of service to clients and the terms and conditions for pharmaceutical contracts.     History. Source: L. 2006: Entire article added with relocations, p. 1905, § 7, effective July 1.    Editor's note:   This section is similar to former § 26-4-407 as it existed prior to 2006.
CO Code § 25.5-5-506 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 5 - Prescription Drugs|§ 25.5-5-506. Prescribed Drugs - Utilization Review

  The state department shall develop and implement a drug utilization review process to assure the appropriate utilization of drugs by patients receiving medical assistance in the fee-for-service and primary care physician programs. The review process shall include the monitoring of prescription information and shall address at a minimum underutilization and overutilization of benefit drugs. Periodic reports of findings and recommendations shall be forwarded to the state department.    It is the general assembly's intent that the implementation of a drug utilization review process for the fee-for-service and primary care physician programs will produce savings within the state's medicaid program. The state department, therefore, is authorized to use savings in the medical services premiums appropriations to fund the development and implementation of a drug utilization review process for these programs, as required by subsection (1) of this section. The state department may contract on a contingency basis for the development or implementation of the review process required by subsection (1) of this section.      The state department shall implement drug utilization mechanisms, including, but not limited to, prior authorization, to control costs in the medical assistance program associated with prescribed drugs. The state board shall promulgate a rule that outlines a process in which any interested party may be notified of and comment on the implementation of any prior authorization for a class of prescribed drugs before the class is prior authorized.    Repealed.         History. Source: L. 2006: Entire article added with relocations, p. 1906, § 7, effective July 1. L. 2016: (3)(b) repealed,(HB 16-1081), ch. 22, p. 51, § 4, effective August 10.    Editor's note:   This section is similar to former § 26-4-408 as it existed prior to 2006.
CO Code § 25.5-5-507 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 5 - Prescription Drugs|§ 25.5-5-507. Prescription Drug Information and Technical Assistance Program - Rules

 There is hereby created the prescription drug information and technical assistance program. The program shall provide advice on the prudent use of prescription drugs to persons who receive prescription drug benefits pursuant to this part 5. The state department shall contract with licensed pharmacists for statewide medicaid pharmacy services and pharmacy consultations for persons receiving prescription drug benefits pursuant to this part 5 regarding how each person may, with the approval of the appropriate prescribing health-care provider, avoid dangerous drug interactions, improve patient outcomes, and save the state money for the drugs prescribed. The state department shall promulgate rules to establish and administer the program and to provide incentive payments to pharmacists and physicians who participate in the program. The state department shall design a calculation for savings under the program.   History. Source: L. 2007: Entire section added, p. 1631, § 2, effective July 1.
CO Code § 25.5-5-509 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 5 - Prescription Drugs|§ 25.5-5-509. Substance Use Disorder - Prescription Drugs

 Notwithstanding any provisions of this part 5 to the contrary, for the treatment of a substance use disorder, in promulgating rules, and subject to any necessary federal authorization, the state board shall authorize reimbursement for at least one federal food and drug administration-approved ready-to-use opioid overdose reversal drug without prior authorization.   History. Source: L. 2018: Entire section added (HB 18-1007), ch. 225, p. 1433, § 6, effective January 1, 2019.
CO Code § 25.5-5-510 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 5 - Prescription Drugs|§ 25.5-5-510. Pharmacy Reimbursement - Substance Use Disorder - Injections

 If a pharmacy has entered into a collaborative pharmacy practice agreement with one or more physicians pursuant to section 12-280-602 to administer injectable antagonist medication for medication-assisted treatment for substance use disorders, the pharmacy administering the drug shall receive an enhanced dispensing fee that aligns with the administration fee paid to a provider in a clinical setting.   History. Source: L. 2018: Entire section added, (HB 18-1007), ch. 225, p. 1433, § 7, effective January 1, 2019. L. 2019: Entire section amended, (HB 19-1172), ch. 136, p. 1710, § 188, effective October 1.
CO Code § 25.5-5-511 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 5 - Prescription Drugs|§ 25.5-5-511. Reimbursement for Pharmacists' Services - Legislative Declaration

     The general assembly finds and declares that:   Pharmacists are highly trained and educated doctorate-level health-care professionals specializing in the effective use of medications and their outcomes;    Pharmacists provide health care throughout the entire health-care system, practicing in community pharmacies, hospitals, provider clinic offices, and specialty areas;    With ninety percent of Americans living within five miles of a pharmacy, pharmacists are able to provide valuable public health services to communities and to provide those services in novel ways, including during nontraditional hours and without appointments;    As part of an integrated team, pharmacists have been proven to lower the overall cost of health care and improve long-term chronic disease outcomes; however, despite these recognized benefits, pharmacists are not considered reimbursable medical providers;    Further, pharmacists in integrated medical homes under the medical assistance program are not supported by the same funding mechanisms as other providers, including rate setting for federally qualified health centers or through fee-for-service billing;    Without the ability to generate revenue through direct reimbursement or new value-based models, the services pharmacists provide are not sustainable;    Colorado has recognized that there is a shortage in primary care providers for individuals enrolled in the medical assistance program; and    Pharmacists can help address this shortage by providing certain primary care services as a follow-up to physician care through collaborative practice models, including the provision of chronic disease management.       Therefore, the general assembly declares that the ability of pharmacists to generate revenue for the same services provided by other health-care providers would be equitable, would help fund staff and services in medical homes, and would alleviate barriers to access of care in community settings.         A pharmacist is eligible to receive reimbursement under the medical assistance program for medically necessary services authorized in part 6 of article 280 of title 12 that are not duplicative of other pharmacist services or programs reimbursed under the medical assistance program.    The state department shall include the services reimbursed pursuant to subsection (2)(a) of this section in the review of provider rates required pursuant to section 25.5-4-401.5.       The state department shall request any federal authorization necessary to receive federal financial participation under the medical assistance program.      History. Source: L. 2021: Entire section added, (HB 21-1275), ch. 470, p. 3377, § 1, effective September 7.
CO Code § 25.5-5-512 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 5 - Prescription Drugs|§ 25.5-5-512. Pharmacy Benefit - Mental Health and Substance Use Disorders - Legislative Declaration

     The general assembly finds and declares that:   It is estimated that over one million Coloradans experience a mental health or substance use disorder each year, yet less than half of the adult population in this state receives the care it needs;    It is well documented that access to appropriate treatments, including medication, can lead to better outcomes for individuals dealing with these diagnoses;    For this reason, policies that restrict access to medications lead to poorer outcomes and increased health-care costs;    Pharmacists also play an important role in improving access to treatments for serious mental illness and substance use disorders; and    The use of extended-release injectable medications for serious mental illness and substance use disorders has research-proven clinical benefits compared to oral medications, including medication adherence and significant delay and reduction in relapse, which decreases criminal recidivism and emergency room visits for patients from vulnerable populations, particularly those experiencing homelessness.       Therefore, the general assembly declares that access to these treatments through a pharmacy benefit under the medical assistance program will improve access to mental health providers by allowing pharmacists to dispense, administer, and be reimbursed for these important and effective medications.       A pharmacist or pharmacy that dispenses or administers extended-release injectable medications for the treatment of mental health or substance use disorders may seek reimbursement for those medications under the medical assistance program either as a pharmacy benefit or as a medical benefit.     History. Source: L. 2021: Entire section added, (HB 21-1275), ch. 470, p. 3377, § 1, effective September 7.
CO Code § 25.5-5-801 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 8 - Children and Youth Behavioral Health System Improvements|§ 25.5-5-801. Legislative Declaration

  The general assembly finds and declares that:   In order to provide quality behavioral health services to families of children and youth with behavioral health challenges, behavioral health services should be coordinated among state departments and political subdivisions of the state and should be culturally competent, cost-effective, and provided in the least restrictive settings;    The behavioral health system and child- and youth-serving agencies are often constrained by resource capacity and systemic barriers that can create difficulties in providing appropriate and cost-effective interventions and services for children and youth;    Children and youth with behavioral health challenges may require a multi-system level of care that can lead to duplication and fragmentation of services. To avoid these problems, keep families together, and support caregivers during a child's or youth's behavioral health challenge, departments and political subdivisions of the state must collaborate with one another.    The Colorado state innovation model, an initiative housed in the office of the governor, has worked to integrate behavioral health and physical health, has made significant progress advancing the use of alternative payment models, and has created infrastructure for screening and innovative payment reforms. However, future work is needed to further expand and improve integrated services for children and families, with a focus on early and upstream interventions.       The general assembly further finds and declares that, building upon work completed by Colorado's trauma-informed system of care, Colorado must implement a model of comprehensive system of care for families of children and youth with behavioral health challenges.     History. Source: L. 2019: Entire part added, (SB 19-195), ch. 190, p. 2098, § 2, effective August 2.
CO Code § 25.5-5-804 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 8 - Children and Youth Behavioral Health System Improvements|§ 25.5-5-804. Integrated Funding Pilot

 Subject to available appropriations, the state department, in conjunction with the department of human services, counties, and other relevant departments, shall design and recommend a child and youth behavioral health delivery system pilot program that addresses the challenges of fragmentation and duplication of behavioral health services. The pilot program shall integrate funding for behavioral health intervention and treatment services across the state to serve children and youth with behavioral health disorders. To implement the provisions of this section, the state department shall collaborate with the department of human services and other relevant stakeholders, including counties, managed care entities, and families.   History. Source: L. 2019: Entire part added, (SB 19-195), ch. 190, p. 2101, § 2, effective August 2. L. 2020: Entire section amended, (HB 20-1384), ch. 172, p. 790, § 3, effective June 29.
CO Code § 25.5-6-103 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 6 - Colorado Medical Assistance Act - Long-Term Care|Part 1 - Long-Term Care Administration|§ 25.5-6-103. Court-Approved Trusts - Transfer of Property for Persons Seeking Medical Assistance - Rule-Making Authority for Trusts Created on or After July 1, 1994 - Undue Hardship

  The state board shall adopt such rules as are necessary with respect to trusts established pursuant to sections 15-14-412.6 to 15-14-412.9. The state board shall adopt rules that address, but need not be limited to, the following:   The definition, including any limitations, of permissible distributions from trusts, taking federal guidelines into consideration;    Reasonable financial reimbursement or incentives to the state department, county departments of human or social services, and any other designated agencies for the efforts and expenses in monitoring trusts, and where necessary, for the recovery of trust property that has been improperly distributed or otherwise expended.       The state board shall comply with Title XIX of the federal “Social Security Act”, 42 U.S.C. sec. 1396p (d)(5), as amended, which requires the state medicaid agency to establish procedures, in accordance with standards specified by the secretary of the United States department of health and human services, under which the state medicaid agency may waive the application of the general rules for considering trust property in determining eligibility for medical assistance if the applicant for medical assistance establishes that the application of the general rules would work an undue hardship on the individual.    The state department shall determine the feasibility of providing ongoing support of dependents by using the trust corpus during the life of the person for whom a trust is created or using the remainder of the trust after the death of the person for whom the trust was created. If the state department determines that it is feasible to provide that support, the state department shall seek a waiver from the federal government to permit the use of trust property for that purpose.     History. Source: L. 2006: Entire article added with relocations, p. 1911, § 7, effective July 1. L. 2018: IP(1) and (1)(b) amended,(SB 18-092), ch. 38, p. 445, § 112, effective August 8.    Editor's note:   This section is similar to former § 26-4-506.6 as it existed prior to 2006.   Cross references:   For the legislative declaration in SB 18-092, see section 1 of chapter 38, Session Laws of Colorado 2018.