As used in this part 3, unless the context otherwise requires:
(1) Comprehensive primary care means the basic, entry-level health care provided by health-care practitioners or non-physician health-care practitioners that is generally provided in an outpatient setting. Comprehensive primary care, at a minimum, includes providing or arranging for the provision of the following services on a year-round basis: Primary health care; maternity care, including prenatal care; preventive, developmental, and diagnostic services for infants and children; adult preventive services; diagnostic laboratory and radiology services; emergency care for minor trauma; pharmaceutical services; and coordination and follow-up for hospital care. Comprehensive primary care may also include optional services based on a patient's needs. For the purposes of this subsection (1) and subsection (2) of this section, arranging for the provision means demonstrating established referral relationships with health-care providers for any of the comprehensive primary care services not directly provided by an entity. An entity in a rural area may be exempt from this requirement if it can demonstrate that there are no providers in the community to provide one or more of the comprehensive primary care services.
(2) Qualified provider means an entity that provides comprehensive primary care services and that:
(a) Accepts all patients regardless of their ability to pay and uses a sliding fee schedule for payments or that provides comprehensive primary care services free of charge;
(b) Serves a designated medically underserved area or population, as provided in section 330(b) of the federal Public Health Service Act, 42 U.S.C. sec. 254b, or demonstrates to the state department that the entity serves a population or area that lacks adequate health-care services for low-income, uninsured persons;
(c) Has a demonstrated track record of providing cost-effective care;
(d) Provides or arranges for the provision of comprehensive primary care services to persons of all ages; and
(e) Completes initial screening for eligibility for the state medical assistance program, the children's basic health plan, and any other relevant government health-care program and referral to the appropriate agency for eligibility determination.
(3) Uninsured or medically indigent patient means a patient receiving services from a qualified provider:
(a) Whose annual household income is at or below two hundred percent of the federal poverty guideline; and
(b) Who is not eligible for medicaid, medicare, or any other type of governmental reimbursement for health-care costs; and
(c) Who is not receiving third-party payments.
Source: L. 2012: Entire part RC&RE, (HB 12-1203), ch. 5, p. 15, � 1, effective March 1. L. 2024: (3)(a) amended, (HB 24-1399), ch. 76, p. 248, � 2, effective July 1, 2025.
25.5-3-302. Annual allocation - primary care services - qualified provider - rules. (1) The state department shall annually allocate the moneys appropriated by the general assembly to the primary care fund created in section 24-22-117 (2)(b), C.R.S., to all eligible qualified providers in the state who comply with the requirements of subsection (2) of this section. The state department shall allocate the moneys in amounts proportionate to the number of uninsured or medically indigent patients served by the qualified provider. For a qualified provider to be eligible for an allocation pursuant to this section, the qualified provider shall meet either of the following criteria:
(a) The qualified provider is a community health center, as defined in section 330 of the federal Public Health Service Act, 42 U.S.C. sec. 254b; or
(b) At least fifty percent of the patients served by the qualified provider are uninsured or medically indigent patients, or patients who are enrolled in the medical assistance program, articles 4, 5, and 6 of this title, or the children's basic health plan, article 8 of this title, or any combination thereof.
(2) (a) A qualified provider shall annually submit to the state department information sufficient to establish the provider's eligibility status as specified in rule by the state board. A qualified provider shall submit an annual application for money that includes the total number of patients served, the number of uninsured or medically indigent patients served who have an annual household income at or below two hundred percent of the federal poverty guideline, and the number of patients served who are enrolled in the medical assistance program, articles 4, 5, and 6 of this title 25.5, or the children's basic health plan, article 8 of this title 25.5.
(b) Each qualified provider shall annually develop and submit to the state department documentation regarding the quality assurance program in place at the provider's facility to ensure that quality comprehensive primary care services are being provided. The state department may, through state board rule, exempt a community health center from the reporting requirements described in this subsection (2)(b).
(c) The data regarding the number of patients served must be verified by an outside entity. For purposes of this part 3, the number of patients served is the number of unduplicated users of health-care services and is not the number of visits by a patient.
(3) (a) The state department shall make annual direct allocations of the total amount of money annually appropriated by the general assembly to the primary care fund pursuant to section 24-22-117 (2)(b), minus three percent for the administrative costs of the program, to all qualified providers.
(b) A qualified provider's allocation is based on the number of uninsured or medically indigent patients served by the provider in proportion to the total number of uninsured or medically indigent patients served by all qualified providers in the previous calendar year.
(c) The state department shall establish a schedule for allocating the money in the primary care fund for qualified providers. The disbursement of money in the primary care fund to qualified providers pursuant to this part 3 is exempt from the provisions of the Procurement Code, articles 101 to 112 of title 24.
(4) Beginning in the 2021-22 state fiscal year, and to the extent available and permitted by the federal government and section 21 of article X of the state constitution, the state department shall maximize federal funds for payment to qualified providers pursuant to this section by aligning payments with the Colorado Medical Assistance Act, articles 4, 5, and 6 of this title 25.5.
(5) The state board shall adopt any rules necessary for the administration and implementation of this part 3.
Source: L. 2012: Entire part RC&RE, (HB 12-1203), ch. 5, p. 16, � 1, effective March 1. L. 2021: (4) amended and (5) added, (SB 21-212), ch. 87, p. 361, � 1, effective May 4. L. 2024: (2) and (3) amended, (HB 24-1399), ch. 76, p. 248, � 3, effective July 1, 2025.