2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 2 - OPTIONAL PROVISIONS (§§ 25.5-5-201 — 25.5-5-208) › Section 25.5-5-202 - [Effective 8/7/2024] Basic services for the categorically needy - optional services

(1)
Subject to the provisions of subsection (2) of this section, the following are services for which federal financial participation is available and that Colorado has selected to provide as optional services under the medical assistance program:
(a)
(I)
Prescribed drugs.
(II)
Notwithstanding subsection (1)(a)(I) of this section, pursuant to section
25.5-5-503
, prescribed drugs are not a covered benefit under the medical assistance program for a member who is enrolled in 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.
(a.5)
Over-the-counter medications, as specified in section 25.5-5-322;
(b)
Clinic services, as defined in sections 25.5-5-301 and 25.5-5-302;
(c)
Home- and community-based services, as specified in article
6
of this title 25.5, which include:
(I)
Home- and community-based services for individuals who are elderly or blind and individuals with disabilities, as specified in part 3 of article
6
of this title;
(II)
Home- and community-based services for persons with intellectual and developmental disabilities, as specified in part 4 of article
6
of this title;
(III)
Repealed.
(IV)
Home- and community-based services for persons with major mental health disorders, as specified in part 6 of article
6
of this title 25.5;
(V)
Home- and community-based services for persons with brain injury, as specified in part 7 of article
6
of this title;
(d)
Optometrist services;
(e)
Eyeglasses when necessary after surgery;
(f)
Prosthetic devices, including medically necessary augmentative communication devices; except that nonsurgically implanted prosthetic devices shall be included only after July 1, 1998, and only if the general assembly approves appropriations for these devices as a new benefit;
(g)
Rehabilitation services as appropriate to behavioral health safety net providers as defined in section 27-50-101;
(h)
Intermediate care facilities for individuals with intellectual disabilities;
(i)
Inpatient psychiatric services for persons under twenty-one years of age;
(j)
Inpatient psychiatric services for persons over the age of sixty-five;
(k)
Case management;
(l)
Therapies under home health services, including:
(I)
Speech and audiology;
(II)
Physical;
(III)
Occupational;
(m)
Services of a licensed psychologist;
(n)
Private duty nursing services;
(o)
Podiatry services;
(p)
Hospice care;
(q)
The program of all-inclusive care for the elderly;
(r)
For any pregnant woman who is enrolled or eligible for services pursuant to section 25.5-5-101(1)(c), alcohol and substance use disorder counseling and treatment, including outpatient and residential care but not including room and board while receiving residential care;
(s)
(I)
Outpatient substance use disorder treatment.
(II)
Repealed.
(t)
Cervical cancer immunization for all females under twenty years of age;
(u)
(I)
Screening, brief intervention, and referral to treatment for individuals at risk of substance abuse, including referral to the appropriate level of intervention and treatment.
(II)
Notwithstanding the provisions of subparagraph (I) of this paragraph (u), services relating to screening, brief intervention, and referral to treatment shall not take effect unless all necessary approvals under federal law and regulation have been obtained to receive federal financial participation for the costs of such services.
(v)
(I)
Counseling by primary care providers and other specialty providers caring for persons with serious, chronic, or terminal illness relating to medical orders for scope of treatment, which counseling may be reimbursed.
(II)
Notwithstanding the provisions of subparagraph (I) of this paragraph (v), counseling relating to medical orders for scope of treatment shall not take effect unless all necessary approvals under federal law and regulation have been obtained to receive federal financial participation for the costs of such services.
(w)
Dental services for adults.
(x)
(I)
Residential and inpatient substance use disorder treatment and medical detoxification services pursuant to section 25.5-5-325.
(II)
Notwithstanding the provisions of subsection (1)(x)(I) of this section, residential and inpatient substance use disorder treatment shall not take effect unless all necessary approvals under federal law and regulation have been obtained to receive federal financial participation for the costs of such services.
(y)
For any perinatal person, comprehensive lactation support services, lactation supplies and equipment, and maintenance of multi-user loaned equipment. An individual trained in advanced lactation support shall provide the lactation support services. Lactation equipment must include a single-user double electric breast pump, pump parts and pump collection kit, and access to a loaned multi-user hospital grade electric breast pump along with a compatible individual collection kit. Individuals must have access to single-user lactation supplies and equipment prior to delivery. Access to multi-user loaned breast pumps shall be authorized by a health-care provider. Access to multi-user loaned breast pumps is prioritized for individuals with premature, medically fragile, low birth weight infants, and with lactation complications. Individuals cannot be required to enroll in separate or additional programs in order to receive covered lactation equipment or lactation support services.
(2)
In addition to the services described in subsection (1) of this section and subject to continued federal financial participation, Colorado has selected to provide transportation services as an administrative cost.
(3)
In order to keep expenditures within approved appropriations, the state board may, by rule, establish limits on a service provided pursuant to this section so long as the service provided is sufficient in the amount, duration, and scope to reasonably achieve the purpose of the service as required by federal law or regulation. When a rule is promulgated pursuant to this subsection (3), the state board shall provide a summary report of the limitations established by the rule and any fiscal impact of the rule to members of the health and human services committees of the senate and house of representatives, or any successor committees, and any other members of the general assembly who request the reports.
(4)
The state department and the behavioral health administration in the department of human services, in collaboration with community mental health services providers and substance use disorder providers, shall establish rules that standardize utilization management authority timelines for the nonpharmaceutical components of medication-assisted treatment for substance use disorders.
Amended by 2024 Ch. 152,§ 44, eff. 8/7/2024.
Amended by 2022 Ch. 222, § 233, eff. 7/1/2024.
Amended by 2022 Ch. 399, § 17, eff. 6/7/2022.
Amended by 2022 Ch. 222, § 69, eff. 7/1/2022.
Amended by 2018 Ch. 313, § 14, eff. 1/1/2019.
Amended by 2018 Ch. 62, § 3, eff. 8/8/2018.
Amended by 2018 Ch. 35, § 25, eff. 8/8/2018.
Amended by 2018 Ch. 373, § 1, eff. 6/5/2018.
Amended by 2017 Ch. 264, § 92, eff. 5/25/2017.
Amended by 2017 Ch. 263, § 199, eff. 5/25/2017.
Amended by 2014 Ch. 250, § 20, eff. 8/6/2014.
Amended by 2014 Ch. 12, § 6, eff. 2/27/2014.
Amended by 2013 Ch. 189, § 1, eff. 8/7/2013.
Amended by 2013 Ch. 117, § 1, eff. 8/7/2013.
Amended by 2013 Ch. 394, § 2, eff. 6/5/2013.
L. 2006: Entire article added with relocations, p. 1860, § 7, effective July 1. L. 2007: (1)(t) added, p. 1348, § 2, effective May 29. L. 2010: (1)(r) amended, (HB 10 - 10 43), ch. 92, p. 313, § 3, effective April 15; (1)(a.5) added, (SB 10 -117), ch. 227, p. 985, § 1, effective July 1; (1)(u) added, (HB 10 - 10 33), ch. 346, p. 1601, § 1, effective August 11. L. 2013: (1)(h) amended, (SB 13-167), ch. 394, p. 2290, § 2, effective June 5; (1)(u)(II) amended and (1)(w) added, (SB 13-242), ch. 189, p. 761, § 1, effective August 7; (1)(v) added, (HB 13-1202), ch. 117, p. 401, § 1, effective August 7. L. 2014: (1)(r) amended, (SB 14-067), ch. 12, p. 114, § 6, effective February 27; (1)(c)(I) and (1)(c)(II) amended, (SB 14-118), ch. 250, p. 985, § 20, effective August 6. L. 2017: IP(1), (1)(r), and (1)(s)(I) amended, (SB 17-242), ch. 263, p. 1327, § 199, effective May 25; (1)(s)(II) repealed, (SB 17-294), ch. 264, p. 1409, § 92, effective May 25. L. 2018: (1)(x) added, (HB 18-1136), ch. 373, p. 2269, § 1, effective June 5; IP(1)(c) and (1)(c)(IV) amended, (SB 18-091), ch. 35, p. 388, § 25, effective August 8; (1)(c)(III) repealed, (SB 18-093), ch. 62, p. 610, § 3, effective August 8; (4) added, (HB 18-1431), ch. 313, p. 1893, § 14, effective 1/1/2019.
(1) This section is similar to former § 26-4-302 as it existed prior to 2006.
(2) The legislative audit committee did not adopt a resolution by March 31, 2011, as provided for in subsection (1)(s)(II).
2024 Ch. 152, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.
For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017. For the legislative declaration in SB 18-091, see section 1 of chapter 35, Session Laws of Colorado 2018. For the legislative declaration in SB 18-093, see section 1 of chapter 62, Session Laws of Colorado 2018.