(1) When dental hygiene services are provided to children by a licensed dental hygienist or dental therapist who is providing dental hygiene services pursuant to section 12-220-503 without the supervision of a licensed dentist, the executive director of the state department shall authorize reimbursement for said services, subject to the requirements of this section. Payment for the services shall be made directly to the licensed dental hygienist or dental therapist, if requested by the licensed dental hygienist or dental therapist; except that this section does not apply to licensed dental hygienists or dental therapists when acting within the scope of their employment as salaried employees of public or private institutions, physicians, or dentists.
(2) For each child provided dental hygiene services pursuant to this section, the dental hygienist or dental therapist shall attempt to identify a dentist participating in medicaid for the child.
Source: L. 2006: Entire article added with relocations, p. 1847, � 7, effective July 1. L. 2019: (1) amended, (HB 19-1172), ch. 136, p. 1707, � 179, effective October 1. L. 2020: (1) amended, (HB 20-1056), ch. 64, p. 263, � 9, effective September 14. L. 2022: Entire section amended, (SB 22-219), ch. 381, p. 2727, � 39, effective January 1, 2023.
Editor's note: This section is similar to former � 26-4-414.3 as it existed prior to 2006.
Cross references: For the legislative declaration in SB 22-219, see section 1 of chapter 381, Session Laws of Colorado 2022.
25.5-4-412. Family planning services - family-planning-related services - rules - definitions. (1) [Editor's note: This version of subsection (1) is effective until January 1, 2026.] When family planning services or family-planning-related services are provided in accordance with this article 4 and articles 5 and 6 of this title 25.5, the executive director of the state department shall authorize reimbursement for the services, subject to section 50 of article V of the state constitution. The state department, any intermediary, or any managed care organization shall reimburse the provider of those services. Family planning services and family-planning-related services are not subject to policy deductibles, copayments, or coinsurance.
(1) [Editor's note: This version of subsection (1) is effective January 1, 2026.] When family planning services or family-planning-related services are provided in accordance with this article 4 and articles 5 and 6 of this title 25.5, the executive director of the state department shall authorize reimbursement for the services. The state department, any intermediary, or any managed care organization shall reimburse the provider of those services. Family planning services and family-planning-related services are not subject to policy deductibles, copayments, or coinsurance.
(2) As used in this section, unless the context otherwise requires:
(a) Family-planning-related services means services provided in a family planning setting as part of or as a follow-up to a family planning visit, including:
(I) Medically necessary evaluations or preventive services, such as tobacco utilization screening, counseling, testing, and cessation services;
(II) Cervical cancer screening and prevention;
(III) Diagnosis or treatment of a sexually transmitted infection or sexually transmitted disease, and medication and supplies to prevent a sexually transmitted infection or sexually transmitted disease; and
(IV) [Editor's note: This version of subsection (2)(a)(IV) is effective until January 1, 2026.] Any other medical diagnosis, treatment, or preventive service that is routinely provided pursuant to a family planning visit.
(IV) [Editor's note: This version of subsection (2)(a)(IV) is effective January 1, 2026.] Any other medical diagnosis, treatment, or preventive service that is routinely provided pursuant to a family planning visit, including abortion care.
(b) Family planning services means all services covered by the federal Title X family planning program, regardless of an individual's age, sex, or gender identity, or the age, sex, or gender identity of the individual's partner, including but not limited to:
(I) All contraception, as defined in section 2-4-401 (1.5);
(II) Health-care and counseling services focused on preventing, delaying, or planning for a pregnancy;
(III) Follow-up visits to evaluate or manage problems associated with contraceptive methods;
(IV) Sterilization services, regardless of an individual's sex; and
(V) Basic fertility services.
(3) (Deleted by amendment, L. 2021.)
(4) For purposes of making payments to providers, the state board shall establish rules implementing this section.
(5) Any member may obtain family planning services or family-planning-related services from any licensed health-care provider, including a doctor of medicine, doctor of osteopathy, physician assistant, advanced practice registered nurse, or certified midwife who provides such services. The enrollment of a member in a managed care organization, or a similar entity, does not restrict a member's choice of the licensed provider from whom the member may receive those services.
(6) The state board shall promulgate rules establishing the specific family-planning-related services and family planning services identified in subsections (2)(a) and (2)(b) of this section. Prior to promulgating the rules, the state department shall engage in a stakeholder process that attempts to include individuals who have received family planning services through the state's medical assistance program or the children's basic health plan, representatives of consumer advocacy organizations, and family planning providers. The stakeholders must be diverse with regard to race, ethnicity, immigration status, age, ability, sexual orientation, gender identity, or geographic region of the state.
Source: L. 2006: Entire article added with relocations, p. 1848, � 7, effective July 1. L. 2016: (2) amended, (SB 16-158), ch. 204, p. 729, � 21, effective August 10. L. 2021: Entire section amended, (SB 21-016), ch. 428, p. 2835, � 3, effective July 6. L. 2023: (5) amended, (SB 23-167), ch. 261, p. 1549, � 62, effective May 25. L. 2024: (5) amended, (SB 24-176), ch. 152, p. 642, � 37, effective August 7. L. 2025: (1) and (2)(a)(IV) amended, (SB 25-183), ch. 97, p. 443, � 3, effective January 1, 2026.
Editor's note: This section is similar to former � 26-4-414.5 as it existed prior to 2006.
Cross references: For the legislative declaration in SB 16-158, see section 1 of chapter 204, Session Laws of Colorado 2016.
25.5-4-413. Certain providers to inform patients of rights concerning advance medical directives. (1) On and after November 5, 1991, with regard to any service rendered on and after said date, each hospital, nursing care facility, home health agency, hospice program, and health maintenance organization participating in the state medical assistance program or providing medical assistance pursuant to parts 3 to 12 of article 6 of this title shall provide written information to all adult patients of such providers concerning patients' rights under state law to make medical treatment decisions, including the right to accept or refuse any medical or surgical treatment and the right to formulate advance directives regarding said decisions. As used in this section, advance directives includes any written or oral instructions recognized under state law concerning the making of medical treatment decisions on behalf of or the provision of medical care for the person who provided the instructions in the event such person becomes incapacitated. Advance directives include, but are not limited to, medical durable powers of attorney, durable powers of attorney, or living wills.
(2) Providers listed in subsection (1) of this section shall provide educational programs for staff and the community concerning advance directives and shall maintain written policies detailing methods for safeguarding patients' rights concerning medical treatment decisions, including documenting in the patient's medical or patient record whether the patient has executed, amended, or revoked an advance directive. No provider shall condition the provision of services or otherwise discriminate against a patient on the basis of whether the patient has executed an advance directive.
Source: L. 2006: Entire article added with relocations, p. 1848, � 7, effective July 1.
Editor's note: This section is similar to former � 26-4-403.5 as it existed prior to 2006.
25.5-4-414. Providers - physicians - prohibition of certain referrals - definitions. (1) As used in this section, unless the context otherwise requires:
(a) Designated health services means any of the following services:
(I) Clinical laboratory services;
(II) Physical therapy services;
(III) Occupational therapy services;
(IV) Radiology and other diagnostic services;
(V) Radiation therapy services;
(VI) Durable medical equipment;
(VII) Parenteral or enteral nutrients, equipment, and supplies;
(VIII) Prosthetics, orthotics, and prosthetic devices;
(IX) Home health services;
(X) Outpatient prescription drugs; and
(XI) Inpatient and outpatient hospital services.
(b) Financial relationship means an ownership or investment interest in an entity furnishing designated health services or a compensation arrangement between a provider or an immediate family member of the provider and the entity. An ownership or investment interest may be reflected in equity, debt, or other instruments.
(c) Immediate family member of the provider means any spouse, natural or adoptive parent, natural or adoptive child, stepparent, stepchild, stepbrother, stepsister, in-law, grandparent, or grandchild of the provider.
(d) Provider means:
(I) A doctor of medicine or osteopathy who is licensed to practice medicine pursuant to article 240 of title 12;
(II) A doctor of dental surgery or of dental medicine who is licensed to practice dentistry pursuant to article 220 of title 12;
(III) A doctor of podiatric medicine who is licensed to practice podiatry pursuant to article 290 of title 12;
(IV) A doctor of optometry who is licensed to practice optometry pursuant to article 275 of title 12; or
(V) A chiropractor who is licensed to practice chiropractic pursuant to article 215 of title 12.
(2) (a) Except as otherwise provided in this subsection (2), a provider participating in the medical assistance program under this article and articles 5 and 6 of this title is prohibited from making a referral to an entity for designated health services for which payment may be made under the state's medical assistance program if the provider or an immediate family member of the provider has a financial relationship with the entity.
(b) Paragraph (a) of this subsection (2) shall not apply to any financial relationship that meets the requirements of an exception to the prohibitions established by 42 U.S.C. sec. 1395nn, as amended, or any regulations promulgated thereunder, as amended.
(c) Paragraph (a) of this subsection (2) shall not apply to a financial relationship or referral for designated health services if the financial relationship or referral for designated health services would not violate 42 U.S.C. sec. 1395nn, as amended, and any regulations promulgated thereunder, as amended, if the designated health services were eligible for payment under medicare rather than the Colorado Medical Assistance Act.
(3) An entity that provides designated health services as a result of a prohibited referral shall not present a claim or bill to any individual, any third-party payor, the state department, or any other entity for the designated health services.
(4) An entity that provides designated health services shall provide to the state department, upon its request and in the form specified by the state department, information concerning the entity's ownership arrangements including:
(a) The items and services provided by the entity;
(b) The names and provider identification numbers of all providers with a financial interest in the entity or whose immediate family members have a financial interest in the entity.
(5) If a provider refers a patient for designated health services in violation of paragraph (a) of subsection (2) of this section or the entity refuses to provide the information required in subsection (4) of this section, the state department may:
(a) Deny any claims for payment from the provider or entity;
(b) Require the provider or entity to refund payments for services;
(c) Refer the matter to the appropriate agency for medical assistance fraud investigation; or
(d) Terminate the provider's or entity's participation in the medical assistance program.
Source: L. 2006: Entire article added with relocations, p. 1849, � 7, effective July 1. L. 2019: (1)(d) amended, (HB 19-1172), ch. 136, p. 1708, � 180, effective October 1.
Editor's note: This section is similar to former � 26-4-410.5 as it existed prior to 2006.