(1) Each contract between the state department and a managed care organization providing mental health services to a member under the medical assistance program must comply with all federal requirements, including but not limited to:
(a) Ensuring that a member with complex or multiple needs who requires mental health services has access to mental health professionals with appropriate training and credentials and providing the member with the services in collaboration with the member's other providers;
(b) Informing each member of the member's right to and the process for appeal upon notification of denial, termination, or reduction of a requested service; and
(c) Administering initial stabilization treatment for a member and transferring the member for appropriate continued services.
(1.5) Each contract between the state department and a managed care organization providing mental health services to a member under the medical assistance program must allow for the use of telemedicine pursuant to section 25.5-5-320.
(2) For mental health managed care members, the state department shall have a patient representative program for member grievances that complies with all federal requirements and that must:
(a) Be posted in a conspicuous place at each location at which mental health services are provided;
(b) Allow for a patient representative to serve as a liaison between the member and the provider;
(c) Describe the qualifications for a patient representative;
(d) Outline the responsibilities of a patient representative;
(e) Describe the authority of a patient representative; and
(f) Establish a method by which each member is informed of the patient representative program and how a patient representative may be contacted.
Source: L. 2006: Entire article added with relocations, p. 1844, � 7, effective July 1. L. 2008: (1.5) added, p. 111, � 1, effective August 5. L. 2024: Entire section amended, (SB 24-176), ch. 152, p. 641, � 36, effective August 7.
Editor's note: This section is similar to former � 26-4-409.5 as it existed prior to 2006.
25.5-4-406. Rate setting - medicaid residential treatment service providers - monitoring and auditing - report. (1) The state department shall approve a rate-setting process consistent with medicaid requirements for providers of medicaid residential treatment services in the state of Colorado as developed by the department of human services. The rate-setting process developed pursuant to this section may include, but shall not be limited to:
(a) A range for reimbursement that represents a base-treatment rate for serving a child who is subject to out-of-home placement due to dependency and neglect, a child placed in a residential child care facility pursuant to the Children and Youth Mental Health Treatment Act, article 67 of title 27, or a child who has been adjudicated a delinquent, which includes a defined service package to meet the needs of the child;
(b) A request for proposal to contract for specialized service needs of a child, including but not limited to: Substance-abuse treatment services; sex offender services; and services for the developmentally disabled; and
(c) Negotiated incentives for achieving outcomes for the child as defined by the state department, counties, and providers.
(2) The medicaid rate-setting process approved by the state department shall include a two- or three-year implementation timeline with implementation beginning in state fiscal year 2008-09.
(3) The state department and the department of human services, in consultation with the representatives of the counties and the provider community, shall review the rate-setting process every two years and shall submit any changes to the joint budget committee of the general assembly.
Source: L. 2006: Entire article added with relocations, p. 1845, � 7, effective July 1. L. 2007: (1)(a), (2), and (3) amended, p. 618, � 2, effective August 3. L. 2010: (1)(a) amended, (SB 10-175), ch. 188, p. 800, � 66, effective April 29. L. 2018: (1)(a) amended, (HB 18-1094), ch. 343, p. 2044, � 10, effective June 30.