reglab/statecodes huggingface dataset:
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 4 - PROVIDERS - REIMBURSEMENT (§§ 25.5-4-401 — 25.5-4-433) › Section 25.5-4-421 - [Repealed]

Added by 2018 Ch. 206,§1, eff. 5/4/2018.
L. 2018: Entire section added, (HB 18-1329), ch. 206, p. 1323, § 1, effective May 4.
Subsection (6) provided for the repeal of this section, effective July 1, 2019. (See L. 2018, p. 1323.)
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 4 - PROVIDERS - REIMBURSEMENT (§§ 25.5-4-401 — 25.5-4-433) › Section 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.
Added by 2019 Ch. 194,§ 7, eff. 5/16/2019.
L. 2019: Entire section added, (HB 19-1233), ch. 2123, p. 2123, § 7, effective May 16.
For the legislative declaration in HB 19-1233, see section 1 of chapter 194, Session Laws of Colorado 2019.
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 4 - PROVIDERS - REIMBURSEMENT (§§ 25.5-4-401 — 25.5-4-433) › Section 25.5-4-424 - [Repealed]

Repealed by subsection (5), eff. 7/1/2022.
Added by 2021 Ch. 89, § 1, eff. 5/4/2021.
L. 2021: Entire section added, (SB 21 -214), ch. 367, p. 367, § 1, effective May 4.
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 4 - PROVIDERS - REIMBURSEMENT (§§ 25.5-4-401 — 25.5-4-433) › Section 25.5-4-425 - Providers - health-care services related to labor and delivery - reimbursement

(1)
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:
(a)
Promotes high-quality, cost-effective, and evidence-based care;
(b)
Promotes high-value, evidence-based payment models; and
(c)
Prevents risk in subsequent pregnancies.
Added by 2021 Ch. 434,§6, eff. 9/7/2021.
L. 2021: Entire section added, (SB 21-194), ch. 2871, p. 2871, § 6, effective September 7.
2021 Ch. 434, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 4 - PROVIDERS - REIMBURSEMENT (§§ 25.5-4-401 — 25.5-4-433) › Section 25.5-4-426 - [Repealed]

Added by 2022 Ch. 16, § 1, eff. 3/7/2022.
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 4 - PROVIDERS - REIMBURSEMENT (§§ 25.5-4-401 — 25.5-4-433) › Section 25.5-4-427 - Supplemental state payment to the Denver health and hospital authority

(1)
The state department shall distribute money appropriated for a payment to the Denver health and hospital authority created in section
25-29-103
.
(2)
[Deleted by 2024 amendment.]
Amended by 2024 Ch. 100,§ 1, eff. 4/18/2024.
Amended by 2024 Ch. 46,§ 3, eff. 4/4/2024.
Added by 2023 Ch. 4, § 2, eff. 3/3/2023.
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 4 - PROVIDERS - REIMBURSEMENT (§§ 25.5-4-401 — 25.5-4-433) › Section 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.
Added by 2023 Ch. 306,§ 2, eff. 8/7/2023.
2023 Ch. 306, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 4 - PROVIDERS - REIMBURSEMENT (§§ 25.5-4-401 — 25.5-4-433) › Section 25.5-4-430 - Increasing access to behavioral health care for children and youth - directed payment authority - fee schedule rates

(1)
(a)
The state department shall analyze how directed payment authority can be used as part of a comprehensive plan to facilitate an adequate network of services for children and youth with behavioral health needs who are under twenty-one years of age and receive medicaid benefits by requiring each managed care entity to pay no less than state department-established fee schedule rates to increase access to care for services needed to promote clinical stabilization. The state department shall analyze how directed payment authority may be applied to clinical stabilization services, including, but not limited to, residential treatment services, multisystemic therapy, functional family therapy, and psychotherapy services for children and youth.
(b)
In analyzing directed payment authority and establishing fee schedule rates, the state department shall consider whether the rates should increase based on the acuity of the child or youth.
(2)
No later than October 1, 2023, the state department shall report to the house of representatives public and behavioral health and human services committee and the senate health and human services committee, or their successor committees, and the joint budget committee whether directed payment authority should be pursued and whether funding should be requested to expand access to residential treatment services, multisystemic therapy, functional family therapy, and psychotherapy services. If the state department determines that directed payments are not appropriate to expand access to such services, the state department shall present an alternative plan to expanding access to the services.
Added by 2023 Ch. 377,§ 1, eff. 6/5/2023.
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 4 - PROVIDERS - REIMBURSEMENT (§§ 25.5-4-401 — 25.5-4-433) › Section 25.5-4-431 - [Effective 8/7/2024] Preauthorization for treatment - request to share with insurance carrier

Subject to state and federal laws relating to the confidentiality of medical records, at the request and with the consent of an enrollee in the medical assistance program, the state department shall provide a copy of the enrollee's preauthorization for treatment to the enrollee's new insurance carrier within ten days after receipt of the request if the enrollee is no longer enrolled in the medical assistance program.
Added by 2024 Ch. 41,§ 4, eff. 8/7/2024.
2024 Ch. 41, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 4 - PROVIDERS - REIMBURSEMENT (§§ 25.5-4-401 — 25.5-4-433) › Section 25.5-4-432 - Reimbursement guidance for screening, brief intervention, and referral to treatment

The state department shall publish guidance for providers concerning reimbursement for all variations of screening, brief intervention, and referral to treatment interventions.
Added by 2024 Ch. 440,§ 8, eff. 6/6/2024.
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 4 - PROVIDERS - REIMBURSEMENT (§§ 25.5-4-401 — 25.5-4-433) › Section 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.
Added by 2024 Ch. 457,§ 3, eff. 6/6/2024.
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 5 - STATE PLAN AMENDMENTS - WAIVER AUTHORITY (§§ 25.5-4-501 — 25.5-4-506) › Section 25.5-4-501 - [Repealed]

L. 2006: Entire article added with relocations, p. 1853, § 7, effective July 1.
(1) This section was similar to former § 26-4-105.8 as it existed prior to 2006.
(2) Subsection (3) provided for the repeal of this section, effective July 1, 2007. (See L. 2006, p. 1853.)
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 5 - STATE PLAN AMENDMENTS - WAIVER AUTHORITY (§§ 25.5-4-501 — 25.5-4-506) › Section 25.5-4-502 - [Repealed]

L. 2006: Entire article added with relocations, p. 1853, § 7, effective July 1.
(1) This section was similar to former § 25.5-1-113 as it existed prior to 2006.
(2) Subsection (3) provided for the repeal of this section, effective July 1, 2007. (See L. 2006, p. 1853.)
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 5 - STATE PLAN AMENDMENTS - WAIVER AUTHORITY (§§ 25.5-4-501 — 25.5-4-506) › Section 25.5-4-503 - Waiver applications - authorization

(1)
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.
(2)
The state department shall pursue and, if approved, implement a demonstration waiver that authorizes the state to use federal medical assistance payments authorized pursuant to section 1903(v) of the federal "Social Security Act", as amended, in coordination with the division of insurance to enhance or expand a state-subsidized individual health coverage plan as defined in section
10-16-1203 (15)
and, only if needed to maximize federal financial participation, for Coloradans receiving state medical assistance pursuant to section
25.5-2-104
or
25.5-5-201 (6)
. To the extent such federal funds are used to enhance or expand a state-subsidized individual health coverage plan, as defined in section
10-16-1203 (15)
, the health insurance affordability enterprise created pursuant to section
10-16-1204
must receive, deposit into the health insurance affordability cash fund created in section
10-16-1206
, and allocate the federal share of the medical assistance payments pursuant to section
10-16-1205 (2)
, subject to any conditions set forth in the approval of the waiver.
Amended by 2022 Ch. 399, § 14, eff. 6/7/2022.
L. 2006: Entire article added with relocations, p. 1853, § 7, effective July 1.
This section is similar to former § 25.5-1-111 as it existed prior to 2006.
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 5 - STATE PLAN AMENDMENTS - WAIVER AUTHORITY (§§ 25.5-4-501 — 25.5-4-506) › Section 25.5-4-504 - [Repealed]

Added by 2019 Ch. 226,§3, eff. 5/20/2019.
L. 2019: Entire section added, (SB 19-222), ch. 2265, p. 2265, § 3, effective May 20.
Subsection (3) provided for the repeal of this section, effective July 1, 2020. (See L. 2019, p. 2265.)
For the legislative declaration in SB 19-222, see section 1 of chapter 226, Session Laws of Colorado 2019.
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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 5 - STATE PLAN AMENDMENTS - WAIVER AUTHORITY (§§ 25.5-4-501 — 25.5-4-506) › Section 25.5-4-505 - Federal authorization related to persons involved in the criminal justice system - assessment - report - repeal

(1)
The state department shall evaluate and determine whether the state should seek additional federal authority to provide screening, brief intervention, and care coordination services through the medical assistance program to persons immediately prior to release from jail or a department of corrections facility and to improve processes for determining and redetermining individuals for medical assistance eligibility in order to improve continuity and access to health-care services. If the state department determines that securing additional federal authority will ensure improved access to care and continuity of care for individuals involved in the criminal justice system, the state department shall, subject to available resources, seek approval from the federal centers for medicare and medicaid services for any additional federal authority. If the state department seeks approval, it shall notify the members of the house of representatives public and behavioral health and human services committee and the senate health and human services committee, or their successor committees, and the members of the joint budget committee of the general assembly. If the state department receives federal approval, the state department, subject to available resources, shall provide the benefits described in this subsection (1).
(2)
If the state department determines that pursuing additional federal authority as described in subsection (1) of this section is inappropriate, the state department shall submit a report to the joint budget committee of the general assembly on or before October 1, 2023, that includes the following information:
(a)
An explanation of why the state department believes pursuing additional federal authority is not an appropriate way to improve continuity of care for justice-involved populations;
(b)
An alternative plan developed by the state department to ensure improved access to care and continuity of care for individuals involved in the criminal justice system who are being released from incarceration that details how the state department plans to ensure continuity of care for individuals being released from jail or prison;
(c)
A proposed timeline for implementation of the alternative plan; and
(d)
Any necessary fiscal or legislative proposals for the implementation of the state department's alternative plan.
(3)
This section is repealed, effective June 30, 2024.
Amended by 2023 Ch. 303,§ 49, eff. 8/7/2023.
Added by 2022 Ch. 193, § 7, eff. 5/19/2022.
2023 Ch. 303, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
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 1 - MANDATORY PROVISIONS (§§ 25.5-5-101 — 25.5-5-105) › Section 25.5-5-102 - [Effective Until 8/7/2024] Basic services for the categorically needy - mandated services

(1)
Subject to the provisions of subsection (2) of this section and section
25.5-4-104
, the program for the categorically needy shall include the following services as mandated and defined by federal law:
(a)
Inpatient hospital services;
(b)
Outpatient hospital services;
(c)
Other laboratory and X-ray services;
(d)
Physicians' services, wherever furnished;
(e)
Nursing facility services;
(f)
Home health services;
(g)
Early and periodic screening, diagnosis, and treatment, as required by federal law;
(h)
Family planning, including a one-year supply of any federal food and drug administration-approved contraceptive drug, device, or product, unless the recipient requests a supply covering a shorter period of time;
(i)
Rural health services;
(j)
Advanced practice registered nurse services;
(k) and (l)
(Deleted by amendment, L. 2008, p. 138, § 2, effective July 1, 2008.)
(m)
Federally qualified health centers.
(2)
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 (2), 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.
Amended by 2021 Ch. 430, § 3, eff. 9/7/2021.
L. 2006: Entire article added with relocations, p. 1856, § 7, effective July 1. L. 2008: (1)(j), (1)(k), and (1)(l) amended, p. 138, § 2, effective July 1. L. 2021: (1)(h) amended, (SB 21-009), ch. 2847, p. 2847, § 3, effective September 7.
This section is similar to former § 26-4-202 as it existed prior to 2006.
2021 Ch. 430, 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.
(1) For the definition of "federally qualified health centers" in the federal "Social Security Act", see 42 U.S.C. sec. 1395x . (2) For the legislative declaration in SB 21-009, see section 1 of chapter 430, Session Laws of Colorado 2021.
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 1 - MANDATORY PROVISIONS (§§ 25.5-5-101 — 25.5-5-105) › Section 25.5-5-102 - [Effective 8/7/2024] Basic services for the categorically needy - mandated services

(1)
Subject to the provisions of subsection (2) of this section and section
25.5-4-104
, the program for the categorically needy must include the following services as mandated and defined by federal law:
(a)
Inpatient hospital services;
(b)
Outpatient hospital services;
(c)
Other laboratory and X-ray services;
(d)
Physicians' services, wherever furnished;
(e)
Nursing facility services;
(f)
Home health services;
(g)
Early and periodic screening, diagnosis, and treatment, as required by federal law;
(h)
Family planning, including a one-year supply of any federal food and drug administration-approved contraceptive drug, device, or product, unless the Member requests a supply covering a shorter period of time;
(i)
Rural health services;
(j)
Advanced practice registered nurse services;
(k) and (l)
(Deleted by amendment, L. 2008, p. 138, § 2, effective July 1, 2008.)
(m)
Federally qualified health centers.
(2)
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 (2), 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.
Amended by 2024 Ch. 152,§ 42, eff. 8/7/2024.
Amended by 2021 Ch. 430, § 3, eff. 9/7/2021.
L. 2006: Entire article added with relocations, p. 1856, § 7, effective July 1. L. 2008: (1)(j), (1)(k), and (1)(l) amended, p. 138, § 2, effective July 1. L. 2021: (1)(h) amended, (SB 21-009), ch. 2847, p. 2847, § 3, effective September 7.
This section is similar to former § 26-4-202 as it existed prior to 2006.
2024 Ch. 152, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2021 Ch. 430, 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.
(1) For the definition of "federally qualified health centers" in the federal "Social Security Act", see 42 U.S.C. sec. 1395x . (2) For the legislative declaration in SB 21-009, see section 1 of chapter 430, Session Laws of Colorado 2021.
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 1 - MANDATORY PROVISIONS (§§ 25.5-5-101 — 25.5-5-105) › Section 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
.
L. 2006: Entire article added with relocations, p. 1857, § 7, effective July 1.
This section is similar to former § 26-4-510 as it existed prior to 2006.
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.
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 1 - MANDATORY PROVISIONS (§§ 25.5-5-101 — 25.5-5-105) › Section 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
.
L. 2006: Entire article added with relocations, p. 1858, § 7, effective July 1.
This section is similar to former § 26-4-511 as it existed prior to 2006.
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 .
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 25.5-5-204.5 - Continuous eligibility - children

(1)
A child who is determined to be eligible for benefits under this article or under article 4 or 6 of this title shall remain eligible for twelve months subsequent to the last day of the month in which the child was enrolled; except that a child shall no longer be eligible and shall be disenrolled from the state medical assistance program if the state department becomes aware of or is notified that the child has moved out of the state or has reached nineteen years of age.
(2)
Notwithstanding the provisions of subsection (1) of this section, if the money in the healthcare affordability and sustainability fee cash fund established pursuant to section
25.5-4-402.4
, together with the corresponding federal matching funds, is insufficient to fully fund all of the purposes described in section
25.5-4-402.4 (5)(b)
, after receiving recommendations from the Colorado healthcare affordability and sustainability enterprise established pursuant to section
25.5-4-402.4 (3)
, the state board by rule adopted pursuant to the provisions of section
25.5-4-402.4 (6)(b)(III)
may eliminate the continuous enrollment requirement pursuant to this section.
(3)
Repealed.
Amended by 2017 Ch. 267, § 20, eff. 7/1/2017.
L. 2009: Entire section added, (HB 09 -1293), ch. 152, p. 648, § 6, effective July 1. L. 2017: (2) amended, (SB 17-267), ch. 267, p. 1466, § 20, effective July 1.
(1) Subsection (3)(c) provided for the repeal of subsection (3), effective the July 1 following the revisor of statutes' receipt of the notice required pursuant to subsection (3)(b). (See L. 2009, p. 648.) The revisor of statutes received said notice dated February 17, 2017.
(2) Section 34 of chapter 267 (SB 17-267), Session Laws of Colorado 2017, provides that the section of the act amending this section does not take effect if the centers for medicare and medicaid services determine that the amendments do not comply with federal law. For more information, see SB 17-267. ( L. 2017, p. 1478.) The executive director of the department of health care policy and financing did not notify the revisor of statutes by June 1, 2017, of such determination; therefore, the changes to this section took effect July 1, 2017.
For the legislative declaration in SB 17-267, see section 1 of chapter 267, Session Laws of Colorado 2017.
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 25.5-5-205 - [Repealed]

Repealed by 2014 Ch. 12, § 7, eff. 2/27/2014.
L. 2006: Entire article added with relocations, p. 1864, § 7, effective July 1. L. 2007: (3)(d) amended, p. 1493, § 5, effective 1/1/2008. L. 2010: (3)(a) and (3)(c)(I) amended, (HB 10 - 10 43), ch. 92, p. 313, § 4, effective April 15. L. 2011: (3)(b) amended, (SB 11 -250), ch. 219, p. 950, § 1, effective May 27; (3)(c) amended, (SB 11 -008), ch. 100, p. 293, § 2, effective September 1. L. 2014: Entire section repealed, (SB 14-067), ch. 12, p. 114, § 7, effective February 27.
This section was similar to former § 26-4-508 as it existed prior to 2006.
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 25.5-5-206 - Medicaid buy-in program - disabled children - disabled adults - federal authorization - rules

(1)
(a)
Subject to available appropriations, the state department is authorized to seek federal authorization to and to establish a medicaid buy-in program or programs for:
(I)
Disabled children; or
(II)
Disabled adults who do not qualify for the medicaid buy-in program established pursuant to part 14 of article
6
of this title.
(b)
The medicaid buy-in program or programs established pursuant to paragraph (a) of this subsection (1) may provide for premium and cost-sharing charges on a sliding fee scale based upon a family's income.
(2)
The state board shall promulgate rules consistent with any federal authorization to implement and administer the medicaid buy-in program or programs established pursuant to paragraph (a) of subsection (1) of this section.
L. 2009: Entire section added, (HB 09-1293), ch. 152, p. 698, §6, effective July 1.
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 3 - SERVICES WITH SPECIAL STATE PROVISIONS (§§ 25.5-5-301 — 25.5-5-338) › Section 25.5-5-302 - Clinic services - children and pregnant women - utilization of certain providers

(1)
The state department shall utilize, to the extent possible and appropriate, county or district public health agencies or boards of health established pursuant to part 5 of article
1
of title
25
, C.R.S., that are certified by the department of public health and environment as qualified to receive payments pursuant to this article and articles
4
and
6
of this title and that meet the requirements and standards set forth in rules promulgated by the state board in the state department pursuant to section
25.5-4-104
to provide clinic services to patients who are children under age seven or patients who are pregnant women.
(2)
In complying with the provisions of subsection (1) of this section, the state department shall utilize, to the extent possible and appropriate, the county or district public health agencies and boards of health specified in subsection (1) of this section to provide outreach to eligible pregnant women and children and to provide clinic services:
(a)
Upon the referral of any physician; or
(b)
When there exists no primary care physician who agrees to provide clinic services to such patients.
L. 2006: Entire article added with relocations, p. 1867, § 7, effective July 1. L. 2010: (1) and IP(2) amended, (HB 10 -1422), ch. 419, p. 2113, § 146, effective August 11.
This section is similar to former § 26-4-514 as it existed prior to 2006.
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 3 - SERVICES WITH SPECIAL STATE PROVISIONS (§§ 25.5-5-301 — 25.5-5-338) › Section 25.5-5-303 - [Effective Until 8/7/2024] Private-duty nursing

(1)
The medical assistance program in this state shall include private-duty nursing to persons who are technology dependent and otherwise eligible as provided under this section.
(2)
A recipient is eligible for private-duty nursing services if he or she:
(a)
Is dependent on technology at least part of each day;
(b)
Requires private-duty nursing care as determined in accordance with state department rules;
(c)
Is able to be served safely under the limitations of the private-duty nursing benefit and within the availability of services; and
(d)
Is not residing in a nursing facility or hospital at the time of the delivery of the private-duty nursing services.
(3)
(a)
The state board shall establish rules in accordance with this section that identify medical criteria for determining the circumstances under which private-duty nursing services will be delivered to assure that only persons who need the services receive them and only to the extent medically necessary.
(b)
Private-duty nursing services shall not be provided as twenty-four-hour care except in special circumstances and for limited time periods as established by the state department pursuant to this section.
(c)
The home health agency, in conjunction with the family or in-home caregiver and the attending physician, shall include in a care plan that includes private-duty nursing services a process by which the eligible person may receive necessary care, which may include respite care, if the family or in-home caregiver is unavailable due to an emergency situation or to unforeseen circumstances. The family or in-home caregiver shall be duly informed by the home health agency of these alternative care provisions at the time the care plan is initiated.
(4)
As used in this section, unless the context otherwise requires, "private-duty nursing" means nursing care that is more individualized and continuous than both the nursing care available under the home health benefit and the nursing care routinely provided in a hospital or nursing facility.
L. 2006: Entire article added with relocations, p. 1867, § 7, effective July 1.
This section is similar to former § 26-4-517 as it existed prior to 2006.
This section is set out more than once due to postponed, multiple, or conflicting amendments.
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 3 - SERVICES WITH SPECIAL STATE PROVISIONS (§§ 25.5-5-301 — 25.5-5-338) › Section 25.5-5-303 - [Effective 8/7/2024] Private-duty nursing

(1)
The medical assistance program in this state shall include private-duty nursing to persons who are technology dependent and otherwise eligible as provided under this section.
(2)
A Member is eligible for private-duty nursing services if the member:
(a)
Is dependent on technology at least part of each day;
(b)
Requires private-duty nursing care as determined in accordance with state department rules;
(c)
Is able to be served safely under the limitations of the private-duty nursing benefit and within the availability of services; and
(d)
Is not residing in a nursing facility or hospital at the time of the delivery of the private-duty nursing services.
(3)
(a)
The state board shall establish rules in accordance with this section that identify medical criteria for determining the circumstances under which private-duty nursing services will be delivered to assure that only persons who need the services receive them and only to the extent medically necessary.
(b)
Private-duty nursing services shall not be provided as twenty-four-hour care except in special circumstances and for limited time periods as established by the state department pursuant to this section.
(c)
The home health agency, in conjunction with the family or in-home caregiver and the attending physician, shall include in a care plan that includes private-duty nursing services a process by which the eligible person may receive necessary care, which may include respite care, if the family or in-home caregiver is unavailable due to an emergency situation or to unforeseen circumstances. The family or in-home caregiver shall be duly informed by the home health agency of these alternative care provisions at the time the care plan is initiated.
(4)
As used in this section, unless the context otherwise requires, "private-duty nursing" means nursing care that is more individualized and continuous than both the nursing care available under the home health benefit and the nursing care routinely provided in a hospital or nursing facility.
Amended by 2024 Ch. 152,§ 47, eff. 8/7/2024.
L. 2006: Entire article added with relocations, p. 1867, § 7, effective July 1.
This section is similar to former § 26-4-517 as it existed prior to 2006.
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.
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 3 - SERVICES WITH SPECIAL STATE PROVISIONS (§§ 25.5-5-301 — 25.5-5-338) › Section 25.5-5-306 - [Repealed]

Amended by 2019 Ch. 136, § 181, eff. 10/1/2019.
Amended by 2018 Ch. 38, § 111, eff. 8/8/2018.
Amended by 2018 Ch. 184, § 2, eff. 7/1/2018.
Amended by 2016 Ch. 210, § 68, eff. 6/6/2016.
Amended by 2013 Ch. 323, § 45, eff. 3/1/2014.
L. 2006: (1) and (3) amended and (4) added, p. 1202, § 2, effective May 26; entire article added with relocations, p. 1871, § 7, effective July 1. L. 2008: (3) amended, p. 1517, § 1, effective May 28. L. 2010: (1) amended, (SB 10-175), ch. 801, p. 801, § 69, effective April 29. L. 2013: (1) amended, (HB 13-1314), ch. 1809, p. 1809, § 45, effective 3/1/2014. L. 2016: (1) amended, (SB 16-189), ch. 773, p. 773, § 68, effective June 6. L. 2018: (5) and (6) added, (HB 18-1328), ch. 1242, p. 1242, § 2, effective July 1; (1) amended, (SB 18-092), ch. 445, p. 445, § 111, effective August 8. L. 2019: (3) and (4) amended, (HB 19-1172), ch. 1708, p. 1708, § 181, effective October 1.
(1) This section was similar to former § 26-4-527 as it existed prior to 2006.
(2) Subsection (6) provided for the repeal of this section, effective June 7, 2019. On August 14, 2019, the revisor of statutes received the notice referred to in subsection (6) related to the repeal. For more information about the repeal and notice, see HB 18-1328. ( L. 2018, p. 1242.)
(1) For the legislative declaration in SB 18-092, see section 1 of chapter 38, Session Laws of Colorado 2018. For the legislative declaration in HB 18-1328, see section 1 of chapter 184, Session Laws of Colorado 2018. (2) For current provisions relating to the residential health care program, see § 25.5-6-903.
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 3 - SERVICES WITH SPECIAL STATE PROVISIONS (§§ 25.5-5-301 — 25.5-5-338) › Section 25.5-5-307 - Child mental health treatment and family support program

(1)
The general assembly finds that many parents in Colorado who have experienced challenging circumstances because their children have significant mental health needs and who have attempted to care for their children or seek services on their behalf often are burdened with the excessive financial and personal costs of providing such care. Private insurance companies may not cover mental health services and rarely cover residential mental health treatment services; those that do seldom cover a sufficient percentage of the expense to make such mental health treatment a viable option for many families in need. The result is that many families do not have the ability to obtain the mental health services that they feel their children desperately need. The general assembly finds that it is in the best interests of these families and the citizens of the state to encourage the preservation of family units by making mental health treatment available to these children pursuant to article
67
of title
27
, C.R.S.
(2)
In order to make mental health treatment available, it is the intent of the general assembly that each medicaid-eligible child who is diagnosed as a person with a mental health disorder, as that term is defined in section
27-65-102
(11.5), must receive mental health treatment, which may include in-home family mental health treatment, other family preservation services, residential treatment, or any post-residential follow-up services, that must be paid for through federal medicaid funding.
Amended by 2017 Ch. 263,§ 202, eff. 5/25/2017.
L. 2006: Entire article added with relocations, p. 1872, § 7, effective July 1; (2) amended, p. 1389, § 19, effective August 7. L. 2010: Entire section amended, (SB 10-175), ch. 188, p. 802, §70, effective April 29. L. 2017: (2) amended, (SB 17-242), ch. 263, p. 1328, § 202, effective May 25.
(1) This section is similar to former § 26-4-509.5 as it existed prior to 2006.
(2) Amendments to section 26-4-509.5(2) by House Bill 06-1277 were harmonized with subsection (2) as it appeared in Senate Bill 06-219.
For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.
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 3 - SERVICES WITH SPECIAL STATE PROVISIONS (§§ 25.5-5-301 — 25.5-5-338) › Section 25.5-5-309 - Pregnant women - needs assessment - referral to treatment program - definition

(1)
The health-care practitioner for each pregnant woman who is enrolled or eligible for services pursuant to section
25.5-5-101 (1)(c)
or
25.5-5-201 (1)
(m.5) is encouraged to identify as soon as possible after the woman is determined to be pregnant whether the woman is at risk of a poor birth outcome due to substance use during the prenatal period and in need of special assistance in order to reduce the risk. If the health-care practitioner makes such determination regarding any pregnant woman, the health-care practitioner is encouraged to refer the woman to any entity approved and licensed by the behavioral health administration in the department of human services for the performance of a needs assessment. Any county department of human or social services may refer an eligible woman for a needs assessment, or any pregnant woman who is eligible for services pursuant to section
25.5-5-201 (1)
(m.5) may refer herself for a needs assessment.
(2)
For the purposes of this section, unless the context otherwise requires, a "needs assessment" means an assessment that is designed to determine the services that are needed for a pregnant woman to minimize the occurrence of a poor birth outcome due to substance use by the pregnant woman.
Amended by 2022 Ch. 222, § 71, eff. 7/1/2022.
Amended by 2019 Ch. 272, § 2, eff. 5/23/2019.
Amended by 2014 Ch. 12, § 13, eff. 2/27/2014.
L. 2006: Entire article added with relocations, p. 1875, § 7, effective July 1. L. 2010: (1) amended, (HB 10 -1043), ch. 314, p. 314, § 6, effective April 15. L. 2014: (1) amended, (SB 14 -067), ch. 116, p. 116, § 13, effective February 27. L. 2019: Entire section amended, (HB 19-1193), ch. 2568, p. 2568, § 2, effective May 23.
This section is similar to former § 26-4-508.2 as it existed prior to 2006.
For the legislative declaration in HB 19-1193, see section 1 of chapter 272, Session Laws of Colorado 2019.
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 3 - SERVICES WITH SPECIAL STATE PROVISIONS (§§ 25.5-5-301 — 25.5-5-338) › Section 25.5-5-311 - Treatment program for high-risk pregnant and parenting women - data collection

The state department, in cooperation with the behavioral health administration in the department of human services, shall create a data collection mechanism regarding persons receiving services pursuant to the treatment program for high-risk pregnant and parenting women that includes the collection of any data that the state department and behavioral health administration in the department of human services deem appropriate.
Amended by 2022 Ch. 222,§73, eff. 7/1/2022.
Amended by 2019 Ch. 272,§4, eff. 5/23/2019.
L. 2006: Entire article added with relocations, p. 1875, § 7, effective July 1.
This section is similar to former § 26-4-508.5 as it existed prior to 2006.
For the legislative declaration in HB 19-1193, see section 1 of chapter 272, Session Laws of Colorado 2019.