reglab/housing_qa huggingface dataset:
CO Code § 25.5-5-321.5 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 3 - Services With Special State Provisions|§ 25.5-5-321.5. Telehealth - Interim Therapeutic Restorations - Reimbursement - Definitions

  Subject to federal authorization and federal financial participation, on or after July 1, 2016, in-person contact between a health-care provider and a recipient is not required under the state's medical assistance program for the diagnosis, development of a treatment plan, instruction to perform an interim therapeutic restoration procedure, or supervision of a dental hygienist performing an interim therapeutic restoration procedure. A health-care provider may provide these services through telehealth, including store-and-forward transfer, and is entitled to reimbursement for the delivery of those services via telehealth to the extent the services are otherwise eligible for reimbursement under the program when provided in person. The services are subject to the reimbursement policies developed pursuant to the state medical assistance program.    As used in this section:   “Interim therapeutic restoration” has the same meaning as set forth in section 12-220-104 (10).    “Store-and-forward transfer” means the asynchronous transmission of medical or dental information to be reviewed by a dentist at a later time at a distant site without the patient present in real time.        History. Source: L. 2015: Entire section added, (HB 15-1309), ch. 326, p. 1334, § 8, effective August 5. L. 2019: (2) amended, (HB 19-1172), ch. 136, p. 1709, § 182, effective October 1. L. 2021: (2)(b) amended, (SB 21-102), ch. 31, p. 130, § 10, effective September 1.
CO Code § 25.5-5-322 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 3 - Services With Special State Provisions|§ 25.5-5-322. Over-the-Counter Medications - Rules

     Subject to approval through the state budget process in paragraph (b) of this subsection (1), the state board shall adopt by rule a system to allow pharmacies to be reimbursed for providing certain over-the-counter medications to recipients if prescribed by a licensed practitioner authorized to prescribe prescription drugs or, subject to the limitations contained in subsection (2) of this section, a licensed pharmacist. Over-the-counter medications subject to reimbursement pursuant to this section shall be identified through the drug utilization review process established in section 25.5-5-506, and shall be limited to medications that, if reimbursed, shall result in overall cost savings to the state.    After the list of over-the-counter medications is identified pursuant to paragraph (a) of this subsection (1), the state department shall request, through the state budget process, that the reimbursements be implemented. The state department shall report to the joint budget committee annually concerning the amount of any savings realized from the reimbursements.         The state board, in consultation with the state board of pharmacy created pursuant to section 12-280-104, shall establish by rule standards for when a licensed pharmacist may prescribe over-the-counter medications as provided under this section for purposes of receiving reimbursement under the medical assistance program.    When prescribing over-the-counter medications under this section, a licensed pharmacist shall consult with the recipient to determine necessity, provide drug counseling, review drug therapy for potential adverse interactions, and make referrals as needed to other health-care professionals.         History. Source: L. 2010: Entire section added, (SB 10-117), ch. 227, p. 985, § 2, effective July 1. L. 2012: (2)(a) amended, (HB 12-1311), ch. 281, p. 1628, § 75, effective July 1. L. 2019: (2)(a) amended, (HB 19-1172), ch. 136, p. 1709, § 183, effective October 1.
CO Code § 25.5-5-324 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 3 - Services With Special State Provisions|§ 25.5-5-324. Nonemergency Medical Transportation - Urgent and Secure Transportation Need - Report - Repeal

  On or before January 1, 2019, the state department shall create and implement an efficient and cost-effective method for meeting urgent transportation needs within the existing nonemergency medical transportation benefit under the medical assistance program. Urgent transportation needs include discharge from inpatient, emergency services, and other urgent but nonemergency services, as determined by the state department.    The method created by the state department must include, at a minimum:   Medical service provider or facility access to approved transportation providers for patients with urgent transportation needs;    Access to transportation providers that have obtained the necessary background checks, drug tests, training, and vehicle inspections, as required by the state department; and    An efficient method for obtaining and paying for transportation services for urgent transportation needs.       The state department may contract for background checks, drug tests, training, and vehicle inspections that may be required pursuant to subsection (2) of this section.      The state department shall annually report on the implementation and effectiveness of the process created in this section for meeting urgent and secure transportation needs within the nonemergency medical transportation benefit and secure transportation services benefit. The state department shall present the report as part of its annual “State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act” presentation required by section 2-7-203 to the health and human services committee of the senate and the public and behavioral health and human services committee of the house of representatives, or any successor committees.    Notwithstanding the provisions of section 24-1-136 (11)(a)(I) to the contrary, the report required pursuant to this section shall continue until the beginning of the 2025 legislative session.    This section is repealed, effective July 1, 2025.         History. Source: L. 2018: Entire section added,(HB 18-1321), ch. 346, p. 2064, § 1, effective May 30. L. 2019: (4)(a) amended,(SB 19-252), ch. 254, p. 2452, § 5, effective August 2. L. 2021: (4)(a) amended,(HB 21-1085), ch. 355, p. 2311, § 3, effective June 27; (4)(a) amended,(SB 21-266), ch. 423, p. 2802, § 23, effective July 2.    Editor's note:   Amendments to subsection (4)(a) by SB 21-266 and HB 21-1085 were harmonized.
CO Code § 25.5-5-327 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 3 - Services With Special State Provisions|§ 25.5-5-327. Eligible Peer Support Services - Reimbursement - Definitions

  As used in this section, unless the context otherwise requires:   “Peer support professional” has the same meaning as defined in section 27-60-108 (2)(b).    “Recovery support services organization” has the same meaning as defined in section 27-60-108 (2)(c).       Subject to available appropriations and to the extent permitted under federal law, the medical assistance program pursuant to this article 5 and articles 4 and 6 of this title 25.5 includes peer support professional services provided to recipients through a recovery support services organization. Peer support professional services must not be provided to recipients until federal approval has been obtained.     History. Source: L. 2021: Entire section added, (HB 21-1021), ch. 256, p. 1509, § 2, effective September 7.
CO Code § 25.5-5-328 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 3 - Services With Special State Provisions|§ 25.5-5-328. Secure Transportation for Behavioral Health Crises - Benefit - Funding

  On or before January 1, 2023, the state department shall create a benefit for secure transportation services, as that term is defined in section 25-3.5-103 (11.4). The state department shall research and create a plan to establish secure transportation services, which may include supplemental and coordinated community response services, to be implemented on or before July 1, 2023. The state department shall collaborate with the office of behavioral health in its research and planning efforts to determine how this benefit may align with co-responder, mobile crisis, and emergency crisis dispatch.    The state department is authorized to seek, accept, and expend gifts, grants, and donations from public or private sources for the purpose of funding the urgent transportation needs within the existing nonemergency medical transportation benefit and secure transportation services benefit under the medical assistance program, as set forth in subsection (1) of this section and section 25.5-5-324 (1).     History. Source: L. 2021: Entire section added, (HB 21-1085), ch. 355, p. 2312, § 4, effective June 27.
CO Code § 25.5-5-330 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 3 - Services With Special State Provisions|§ 25.5-5-330. Screening for Perinatal Mood and Anxiety Disorder

  For the caregiver of each child enrolled in the medical assistance program in the state, the program must include screening for perinatal mood and anxiety disorders in accordance with the health resources and services administration guidelines.    The screening must be made available to the caregiver of each child enrolled in the medical assistance program, regardless of whether the caregiver is enrolled in the medical assistance program, so long as the caregiver's child is enrolled in the medical assistance program.     History. Source: L. 2021: Entire section added,(SB 21-137), ch. 362, p. 2366, § 12, effective June 28.    Cross references:   For the short title (“Behavioral Health Recovery Act of 2021”) and the legislative declaration in SB 21-137, see sections 1 and 2 of chapter 362, Session Laws of Colorado 2021.
CO Code § 25.5-5-331 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 3 - Services With Special State Provisions|§ 25.5-5-331. Federally Qualified Health Center - Clinical Pharmacy Services - Reimbursement - Rules

  Costs associated with services provided by clinical pharmacists through a federally qualified health center, as defined in the federal “Social Security Act”, 42 U.S.C. sec. 1395x (aa)(4), are considered allowable costs for the purpose of a federally qualified health center's cost report and must be included in the calculation of the reimbursement rate for a patient visit at a federally qualified health center.    The state department shall promulgate rules to implement the provisions of this section.     History. Source: L. 2021: Entire section added, (HB 21-1275), ch. 470, p. 3379, § 2, effective September 7.
CO Code § 25.5-5-401 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 4 - Statewide Managed Care System|§ 25.5-5-401. Short Title

 This part 4 shall be known and may be cited as the “Statewide Managed Care System”.   History. Source: L. 2006: Entire article added with relocations, p. 1883, § 7, effective July 1.    Editor's note:   This section is similar to former § 26-4-111 as it existed prior to 2006.
CO Code § 25.5-5-410 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 4 - Statewide Managed Care System|§ 25.5-5-410. Data Collection for Managed Care Programs

  Repealed.    The state department of human services, in conjunction with the state department, shall continue its existing efforts, which include obtaining and considering consumer input, to develop managed care systems for the developmentally disabled population and to consider a pilot program for a certificate system to enable the developmentally disabled population to purchase managed care services or fee-for-service care, including long-term care community services. The department of human services shall not implement any managed care system for developmentally disabled services without the express approval of the joint budget committee. Any proposed implementation of fully capitated managed care in the developmental disabilities community service system shall require legislative review.    In addition to any other data collection and reporting requirements, each managed care organization shall submit the following types of data to the state department or its agent:   Medical access;    Consumer outcomes based on statistics maintained on individual consumers as well as the total consumer populations served;    Consumer satisfaction;    Consumer utilization;    Health status of consumers; and    Uncompensated care delivered.        History. Source: L. 2006: Entire article added with relocations, p. 1896, § 7, effective July 1. L. 2008: (1) amended, p. 402, § 6, effective August 5. L. 2016: (1) repealed and (2) amended,(HB 16-1081), ch. 22, p. 51, § 3, effective August 10.    Editor's note:   This section is similar to former § 26-4-121 as it existed prior to 2006.
CO Code § 25.5-5-413 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 4 - Statewide Managed Care System|§ 25.5-5-413. Direct Contracting With Providers - Legislative declaration.(repealed)

 History. Source: L. 2006: Entire article added with relocations, p. 1902, § 7, effective July 1. L. 2018: Entire section repealed,(HB 18-1431), ch. 313, p. 1891, § 7, effective August 8.    Editor's note:   This section was similar to former § 26-4-127 as it existed prior to 2006.
CO Code § 25.5-5-418 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 4 - Statewide Managed Care System|§ 25.5-5-418. Primary Care Provider Sustainability Fund - Creation - Use of Fund

 The primary care provider sustainability fund is hereby created in the state treasury. The fund consists of money transferred to the fund from the children's basic health plan trust created in section 25.5-8-105 (1) pursuant to section 25.5-8-105 (8)(b) and any other money that the general assembly may appropriate or transfer to the fund. The state treasurer shall credit all interest and income derived from the deposit and investment of money in the fund to the fund. Any unexpended and unencumbered money in the fund at the end of any fiscal year remains in the fund and shall not be credited or transferred to the general fund or any other fund. Subject to annual appropriation by the general assembly, the state department may expend money from the fund for the purpose of increasing access to primary care through rate enhancements for primary care office visits, preventive medicine visits, counseling and health-risk assessments, immunization administration, health screening services, and newborn care, including neonatal critical care. Money expended from the fund for the purposes of increasing access to primary care through rate enhancements supplements and does not supplant general fund appropriations for that purpose.   History. Source: L. 2016: Entire section added, (HB 16-1408), ch. 153, p. 468, § 18, effective July 1.
CO Code § 25.5-5-420 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 4 - Statewide Managed Care System|§ 25.5-5-420. Advancing Care for Exceptional Kids

 Within one hundred twenty days of the enactment of the federal “Advancing Care for Exceptional Kids Act”, subject to available appropriations, the state department shall seek any federal approval necessary to fund, in cooperation with hospitals that meet the specified requirements, the implementation of an enhanced pediatric health home for children with complex medical conditions. Requirements for participation by the state department, along with the requirement of an enhanced pediatric health home, are stipulated by the “Advancing Care for Exceptional Kids Act” and shall be complied with accordingly.   History. Source: L. 2017: Entire section added,(SB 17-267), ch. 267, p. 1466, § 21, effective May 30.    Cross references:   For the legislative declaration in SB 17-267, see section 1 of chapter 267, Session Laws of Colorado 2017.
CO Code § 25.5-5-422 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 4 - Statewide Managed Care System|§ 25.5-5-422. Medication-Assisted Treatment - Limitations on Mces - Definition

  As used in this section, “FDA” means the food and drug administration in the United States department of health and human services.    Notwithstanding any provision of law to the contrary, beginning January 1, 2020, each MCE that provides prescription drug benefits for the treatment of substance use disorders shall:   Not impose any prior authorization requirements on any prescription medication approved by the FDA for the treatment of substance use disorders;    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; and    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.        History. Source: L. 2019: Entire section added,(HB 19-1269), ch. 195, p. 2136, § 15, effective May 16.    Cross references:   For the short title (“Behavioral Health Care Coverage Modernization Act”) in HB 19-1269, see section 1 of chapter 195, Session Laws of Colorado 2019.
CO Code § 25.5-5-423 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 4 - Statewide Managed Care System|§ 25.5-5-423. Independent Review Organization - Review Denial of Residential and Inpatient Substance Use Disorder Treatment Claims - Contract

 No later than July 1, 2023, the state department shall contract with one or more independent review organizations to conduct external medical reviews requested for review by a medicaid provider when there is a denial or reduction for residential or inpatient substance use disorder treatment and medicaid appeals processes have been exhausted.   History. Source: L. 2021: Entire section added,(SB 21-137), ch. 362, p. 2364, § 9, effective June 28.    Cross references:   For the short title (“Behavioral Health Recovery Act of 2021”) and the legislative declaration in SB 21-137, see sections 1 and 2 of chapter 362, Session Laws of Colorado 2021.
CO Code § 25.5-5-424 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 4 - Statewide Managed Care System|§ 25.5-5-424. Residential and Inpatient Substance Use Disorder Treatment - Mce Standardized Utilization Management Process - Medical Necessity - Report

  On or before October 1, 2021, the state department shall consult with the office of behavioral health in the department of human services, residential treatment providers, and MCEs to develop standardized utilization management processes to determine medical necessity for residential and inpatient substance use disorder treatment. The processes must incorporate the most recent edition of “The ASAM Criteria for Addictive, Substance-related, and Co-occurring Conditions” and align with federal medicaid payment requirements.    On or before January 1, 2022, the state department shall incorporate the standards developed pursuant to subsection (1) of this section into existing MCE contracts, and each MCE shall adhere to the standards when conducting utilization management for residential and inpatient substance use disorder treatment.    On or before January 1, 2022, each MCE's notice of an adverse benefit determination must demonstrate how each dimension of the most recent edition of “The ASAM Criteria for Addictive, Substance-related, and Co-occurring Conditions” was considered when determining medical necessity.      Beginning October 1, 2021, and quarterly thereafter, the state department shall collaborate with the office of behavioral health in the department of human services, residential treatment providers, and MCEs to develop a report on the residential and inpatient substance use disorder utilization management statistics. At a minimum, the report must include:   The average length of an initial authorization and the average length of continued authorizations for each MCE and provider disaggregated by level of residential care;    Denials of initial authorizations reported for each MCE and provider and the reasons for the denials; and    The average response time for an initial authorization and continued authorization, disaggregated by each MCE; level of residential care, including the percentage of extensions granted to health-care providers to submit complete clinical documentation; retroactive authorization requests; incomplete authorization requests; and the number of requests that met and did not meet the state department's response time requirements.       The state department shall make the report developed pursuant to subsection (4)(a) of this section publicly available on the state department's website.    Any information required to be reported pursuant to subsection (4)(a) of this section may be aggregated as necessary to ensure confidentially pursuant to 42 CFR part 2.         History. Source: L. 2021: Entire section added,(SB 21-137), ch. 362, p. 2365, § 10, effective June 28.    Cross references:   For the short title (“Behavioral Health Recovery Act of 2021”) and the legislative declaration in SB 21-137, see sections 1 and 2 of chapter 362, Session Laws of Colorado 2021.
CO Code § 25.5-5-425 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 5 - Colorado Medical Assistance Act - Services and Programs|Part 4 - Statewide Managed Care System|§ 25.5-5-425. Audit of Mce Denials for Residential and Inpatient Substance Use Disorder Treatment Authorization - Report

  No later than July 1, 2022, the state department shall contract with an independent third-party vendor to audit thirty-three percent of all denials of authorization for inpatient and residential substance use disorder treatment for each MCE.    Beginning December 1, 2022, and each December 1 thereafter, the state department shall submit the results of the audit conducted pursuant to subsection (1) of this section and any recommended changes to the residential and inpatient substance use disorder benefit to the house of representatives health and insurance committee, the house of representatives public and behavioral health and human services committee, the senate health and human services committee, or their successor committees, and the joint budget committee.     History. Source: L. 2021: Entire section added,(SB 21-137), ch. 362, p. 2366, § 11, effective June 28.    Cross references:   For the short title (“Behavioral Health Recovery Act of 2021”) and the legislative declaration in SB 21-137, see sections 1 and 2 of chapter 362, Session Laws of Colorado 2021.