(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.
Source: 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.
Editor's note: (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.
Cross references: For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.
25.5-5-308. Breast and cervical cancer prevention and treatment program - creation - legislative declaration - definitions - funds - repeal. (1) The general assembly hereby finds and declares that breast and cervical cancer are significant health problems for women in this state. The general assembly further finds and declares that these cancers can and should be prevented and treated whenever possible. It is therefore the intent of the general assembly to enact this section to provide for the prevention and treatment of breast and cervical cancer to women where it is not otherwise available for reasons of cost.
(2) As used in this section, unless the context otherwise requires:
(a) Eligible person means a person who:
(I) (A) Has been screened for breast or cervical cancer under the centers for disease control and prevention's national breast and cervical cancer early detection program established under Title XV of the federal Public Health Service Act, 42 U.S.C. sec. 300k et seq., in accordance with the requirements of section 1504 of such act, 42 U.S.C. sec. 300n, on or after July 1, 2002, unless the federal centers for medicare and medicaid services approves the state department's amendment to the medical assistance plan and the state department is able to implement the breast and cervical cancer prevention and treatment program before such date, then the person must be screened on or after the implementation date of such program; or
(B) Has been screened for breast or cervical cancer by any provider, within the provider's scope of practice, who does not receive funds through the federal centers for disease control and prevention's national breast and cervical cancer early detection program but whose screening activities are recognized by the department of public health and environment as part of screening activities under the centers for disease control and prevention's national breast and cervical cancer early detection program;
(II) Has been diagnosed with breast or cervical cancer and is in need of breast or cervical cancer treatment;
(III) Has not yet attained sixty-five years of age; and
(IV) Does not have any creditable coverage as defined under federal law pursuant to 42 U.S.C. sec. 300gg-3 (c).
(b) Qualified entity shall be defined pursuant to 42 U.S.C. sec. 1396r-1b(b)(2).
(3) There is hereby created a breast and cervical cancer prevention and treatment program to provide medical benefits to eligible persons under this section.
(4) (a) Benefits for medical assistance to an eligible person shall be made available beginning on the day on which a determination is made that the person is eligible for medical assistance and throughout the period in which such person meets the definition of an eligible person.
(b) Benefits for medical assistance to an eligible person shall also be available for the following period of presumptive eligibility:
(I) Such period of presumptive eligibility shall begin when a qualified entity determines that the eligible person is in need of treatment for breast or cervical cancer.
(II) Such period of presumptive eligibility shall end with the earlier of:
(A) The day on which a determination is made that the person is eligible or not eligible for medical assistance; or
(B) If the eligible person does not file a simplified application for medical assistance developed by the state department and approved by the federal centers for medicare and medicaid services on or before the last day of the month following the month during which the eligible person was found to be qualified for services under this section, then benefits shall end on such last day.
(5) The state department shall have the following powers and duties:
(a) To establish, operate, and monitor the breast and cervical cancer prevention and treatment program to provide medical assistance to eligible persons in accordance with the provisions of the federal Breast and Cervical Cancer Prevention and Treatment Act of 2000, enacted October 24, 2000, Pub.L. 106-354, as amended;
(b) To amend the state's medical assistance plan to incorporate the breast and cervical cancer prevention and treatment program. The state department shall submit such proposed amendment to the federal centers for medicare and medicaid services regional office for approval.
(c) To accept and expend any grant or award of moneys from the federal government, any moneys appropriated by the general assembly, any moneys received through gifts, grants, or donations from nonprofit or for-profit entities, and any interest and income earned on such moneys for the purposes set forth in this section;
(d) To inform the joint budget committee of the general assembly in writing as soon as practicable about any change in the rate of federal financial participation in the program.
(6) The state board shall adopt such rules as are necessary to carry out the provisions of this section.
(7) The breast and cervical cancer prevention and treatment program is subject to the annual financial and compliance audit of the Colorado Medical Assistance Act performed by the state auditor's office and shall not be considered a tobacco settlement program for purposes of section 2-3-113, C.R.S.
(8) (a) (I) There is created in the state treasury the breast and cervical cancer prevention and treatment fund, referred to in this subsection (8) as the fund. The fund consists of money credited to the fund pursuant to section 24-22-115 (1); any gifts, grants, and donations; any money appropriated or transferred to the fund by the general assembly; and money credited to the fund pursuant to section 42-3-217.5 (3)(c). All money credited to the fund and all interest and income earned on the money in the fund remains in the fund for the purposes set forth in this section. Any unexpended and unencumbered money remaining in the fund at the end of a fiscal year remains in the fund and shall not be credited or transferred to the general fund or another fund. The state department is encouraged to secure private gifts, grants, and donations to fund the state costs of the breast and cervical cancer prevention and treatment program.
(II) Moneys in the fund may be used to cover the administrative costs of the department of public health and environment to recognize providers in accordance with sub-subparagraph (B) of subparagraph (I) of paragraph (a) of subsection (2) of this section as providing screening activities under the centers for disease control and prevention's national breast and cervical cancer early detection program.
(b) to (c) Repealed.
(9) (a) For the fiscal year 2005-06, the general assembly shall appropriate fifty percent of the state costs of the breast and cervical cancer prevention and treatment program from the general fund and fifty percent from the moneys credited to the breast and cervical cancer prevention and treatment fund pursuant to section 24-22-115 (1), C.R.S., to such program.
(b) For the fiscal year 2006-07, the general assembly shall appropriate seventy-five percent of the state costs of the breast and cervical cancer prevention and treatment program from the general fund and twenty-five percent from the moneys credited to the breast and cervical cancer prevention and treatment fund pursuant to section 24-22-115 (1), C.R.S., to such program.
(c) For the fiscal year 2007-08, the general assembly shall appropriate one hundred percent of the state costs of the breast and cervical cancer prevention and treatment program from the moneys credited to the breast and cervical cancer prevention and treatment fund pursuant to section 24-22-115 (1), C.R.S., to such program.
(d) For the fiscal year 2008-09, the general assembly shall appropriate one hundred percent of the state costs of the breast and cervical cancer prevention and treatment program from the moneys credited to the breast and cervical cancer prevention and treatment fund pursuant to section 24-22-115 (1), C.R.S., to such program.
(e) For the fiscal years 2009-10 through 2011-12, the general assembly shall annually appropriate one hundred percent of the state costs of the breast and cervical cancer prevention and treatment program from the moneys credited to the breast and cervical cancer prevention and treatment fund pursuant to section 24-22-115 (1), C.R.S., to such program.
(f) For the fiscal years 2012-13 and 2013-14, the general assembly shall annually appropriate fifty percent of the state costs of the breast and cervical cancer prevention and treatment program from the general fund and fifty percent from the moneys credited to the breast and cervical cancer prevention and treatment fund pursuant to section 24-22-115 (1), C.R.S., to such program.
(g) For the fiscal years 2014-15 through 2028-29, the general assembly shall annually appropriate one hundred percent of the state costs of the breast and cervical cancer prevention and treatment program from the money credited to the breast and cervical cancer prevention and treatment fund to the program; except that, if the money in the breast and cervical cancer prevention and treatment fund is insufficient to fully fund the program, the general assembly shall appropriate sufficient money from the general fund.
(h) For the 2024-25, 2025-26, and 2026-27 state fiscal years, the state treasurer shall transfer five hundred thousand dollars from the fund to the breast cancer screening fund created in section 25-4-1503.
(10) This section is repealed, effective July 1, 2029, unless, in any fiscal year before such date, money received as federal financial participation provided pursuant to the federal Breast and Cervical Cancer Prevention and Treatment Act of 2000, enacted October 24, 2000, Pub.L. 106-354, as amended, is no longer available to the fund or the rate of federal financial participation has been decreased, in which case the general assembly may repeal this section at the regular session of the general assembly immediately following such decrease or discontinuation of federal money.
Source: L. 2006: (8) amended, p. 1117, � 2, effective May 25; entire article added with relocations, p. 1872, � 7, effective July 1. L. 2008: (8)(a), (9)(b), (9)(c), and (10) amended and (9)(d) and (9)(e) added, p. 1830, � 1, effective June 2. L. 2009: (9)(e) amended and (9)(f) added, (SB 09-262), ch. 202, p. 912, � 1, effective May 1; (2)(a)(I) and (8)(a) amended and (8)(c) added, (HB 09-1164), ch. 215, p. 973, � 4, effective May 2. L. 2013: (8)(a)(I) and (8)(c)(II) amended, (8)(b) repealed, and (8)(b.5) added, (SB 13-276), ch. 256, p. 1352, � 8, effective May 23. L. 2014: (2)(a)(I)(B), (8)(a)(I), and (10) amended, (8)(c) repealed, and (9)(g) added, (HB 14-1045), ch. 137, p. 468, � 1, effective July 1. L. 2015: (7) amended, (SB 15-189), ch. 104, p. 304, � 5, effective April 16. L. 2018: (2)(a)(IV) and (8)(b.5) amended, (HB 18-1375), ch. 274, p. 1714, � 64, effective May 29. L. 2019: (9)(g) and (10) amended, (HB 19-1302), ch. 193, p. 2115, � 1, effective May 16. L. 2023: (2)(a)(I)(B), (4)(b)(II)(B), and (5)(b) amended, (HB 23-1301), ch. 303, p. 1831, � 50, effective August 7. L. 2024: (8)(a)(I) amended, (8)(b.5) repealed, and (9)(h) added, (SB 24-086), ch. 413, p. 2843, � 2, effective June 5; (8)(b.5) amended (HB 24-1360), ch. 324, p. 2167, � 8, effective July 1; (2)(a)(I)(A) amended, (HB 24-1450), ch. 490, p. 3420, � 62, effective August 7.
Editor's note: (1) This section is similar to former � 26-4-532 as it existed prior to 2006.
(2) Subsection (8) was originally numbered as � 26-4-532 (7), and the amendments to it in Senate Bill 06-128 were harmonized with subsection (8) as it appeared in Senate Bill 06-219.
(3) Subsection (8)(b.5) was amended in HB 24-1360, effective July 1, 2024. Those amendments were superseded by the repeal of subsection (8)(b.5) in SB 24-086, effective June 5, 2024.
Cross references: (1) For the Breast and Cervical Cancer Prevention and Treatment Act of 2000, Pub.L. 106-354, see 42 U.S.C. sec. 1396r-1b.
(2) For the legislative declaration in HB 09-1164, see section 1 of chapter 215, Session Laws of Colorado 2009. For the legislative declaration in HB 24-1360, see section 1 of chapter 324, Session Laws of Colorado 2024.
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.
Source: L. 2006: Entire article added with relocations, p. 1875, � 7, effective July 1. L. 2010: (1) amended, (HB 10-1043), ch. 92, p. 314, � 6, effective April 15. L. 2014: (1) amended, (SB 14-067), ch. 12, p. 116, � 13, effective February 27. L. 2019: Entire section amended, (HB 19-1193), ch. 272, p. 2568, � 2, effective May 23. L. 2022: (1) amended, (HB 22-1278), ch. 222, p. 1513, � 71, effective July 1.
Editor's note: This section is similar to former � 26-4-508.2 as it existed prior to 2006.
Cross references: For the legislative declaration in HB 19-1193, see section 1 of chapter 272, Session Laws of Colorado 2019.
25.5-5-310. Treatment program for high-risk pregnant and parenting women - cooperation with private entities - definition. (1) (a) As used in this section, parenting woman means a woman up to one year postpartum who is in need of substance use disorder services.
(b) The state department, the behavioral health administration in the department of human services, the department of human services, and the department of public health and environment shall cooperate with any organizations that desire to assist the departments and the administration in the provision of services connected with the treatment program for high-risk pregnant and parenting women. Organizations may provide services that are not provided to persons pursuant to this article 5 or article 4 or 6 of this title 25.5 or article 2 of title 26, which services may include but are not limited to needs assessment services, preventive services, rehabilitative services, care coordination, nutrition assessment, psychosocial counseling, intensive health education, home visits, transportation, development of provider training, child care, child care navigation, and other necessary components of residential or outpatient treatment or care.
(2) (a) Health-care practitioners and county departments of human or social services are encouraged to identify any pregnant or parenting woman. If a practitioner or county department of human or social services makes such determination regarding any pregnant or parenting woman up to one year postpartum, the practitioner or county department of human or social services is encouraged to refer the woman to any entity approved and licensed by the behavioral health administration in the department of human services for a needs assessment in order to improve outcomes for the pregnant or parenting woman and child and reduce the likelihood of out-of-home placement. Any pregnant or parenting woman up to one year postpartum may also refer herself for a needs assessment.
(b) The behavioral health administration in the department of human services is authorized to use state money to provide services to women, including women enrolled in the medical assistance program established pursuant to this article 5 and articles 4 and 6 of this title 25.5, who enroll, up to one year postpartum, in residential substance use disorder treatment and recovery services, until such time as those services are covered by the medical assistance program. The behavioral health administration in the department of human services may continue to use state money to enroll parenting women in residential services who qualify as indigent but who are not eligible for services under the medical assistance program.
(c) Facilities approved and licensed by the behavioral health administration in the department of human services to provide substance use disorder services to high-risk pregnant and parenting women and that offer child care services must allow a woman to begin treatment without first presenting up-to-date health records for her child, including those referenced in section 25-4-902. The parenting woman in treatment must present up-to-date health records for her child, including those referenced in section 25-4-902, within thirty days after commencing treatment.
Source: L. 2006: Entire article added with relocations, p. 1875, � 7, effective July 1. L. 2019: Entire section amended, (HB 19-1193), ch. 272, p. 2568, � 3, effective May 23. L. 2021: (2)(b) amended, (HB 21-1021), ch. 256, p. 1511, � 5, effective September 7. L. 2022: (1)(b) and (2) amended, (HB 22-1278), ch. 222, p. 1514, � 72, effective July 1.
Editor's note: This section is similar to former � 26-4-508.4 as it existed prior to 2006.
Cross references: For the legislative declaration in HB 19-1193, see section 1 of chapter 272, Session Laws of Colorado 2019.
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.
Source: L. 2006: Entire article added with relocations, p. 1875, � 7, effective July 1. L. 2019: Entire section amended, (HB 19-1193), ch. 272, p. 2569, � 4, effective May 23. L. 2022: Entire section amended, (HB 22-1278), ch. 222, p. 1514, � 73, effective July 1.
Editor's note: This section is similar to former � 26-4-508.5 as it existed prior to 2006.
Cross references: For the legislative declaration in HB 19-1193, see section 1 of chapter 272, Session Laws of Colorado 2019.
25.5-5-312. Treatment program for high-risk pregnant and parenting women - extended coverage - federal approval. (1) The state department shall seek federal approval to continue providing substance use disorder treatment and recovery services for twelve months following a pregnancy to women who are eligible to receive services under the medical assistance program, who are receiving services pursuant to the treatment program for high-risk pregnant and parenting women, and who continue to participate in the treatment program. The state department shall implement the continued services to the extent allowed by the federal government.
(2) The state department is authorized to request any federal changes necessary to permit high-risk pregnant and parenting women to further access treatment for pregnant and parenting women with substance use disorders. Any changes to federal waiver programs for this population must preserve the family-oriented specialty services needed by pregnant and parenting women and their dependent children, including those services described in section 25.5-5-310 (1).
Source: L. 2006: Entire article added with relocations, p. 1876, � 7, effective July 1. L. 2019: Entire section amended, (HB 19-1193), ch. 272, p. 2570, � 5, effective May 23. L. 2021: (1) amended, (HB 21-1021), ch. 256, p. 1511, � 6, effective September 7.
Editor's note: This section is similar to former � 26-4-508.6 as it existed prior to 2006.
Cross references: For the legislative declaration in HB 19-1193, see section 1 of chapter 272, Session Laws of Colorado 2019.
25.5-5-313. Outpatient substance abuse treatment - report of state auditor - amendment to state plan - repeal. (Repealed)
Source: L. 2006: Entire article added with relocations, p. 1876, � 7, effective July 1.
Editor's note: (1) This section was similar to former � 26-4-536 as it existed prior to 2006.
(2) Subsection (3) provided for the repeal of this section, effective July 1, 2011. (See L. 2006, p. 1876.)
25.5-5-314. Substance use disorder treatment for Native Americans - federal approval. (1) The state department shall request federal approval, conditioned on the receipt of gifts, grants, or donations sufficient to provide for the state's administrative costs of preparing and submitting the request, to include any substance use disorder treatment benefits available to Native Americans in which there is one hundred percent federal financial participation.
(2) Repealed.
Source: L. 2006: Entire article added with relocations, p. 1876, � 7, effective July 1. L. 2014: (2) repealed, (HB 14-1363), ch. 302, p. 1269, � 30, effective May 31. L. 2017: (1) amended, (SB 17-242), ch. 263, p. 1328, � 203, effective May 25.
Editor's note: This section is similar to former � 26-4-422 as it existed prior to 2006.
Cross references: For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.
25.5-5-315. Acceptance of gifts, grants, and donations - Native American substance abuse treatment cash fund. (1) The executive director may accept and expend money from gifts, grants, and donations for purposes of providing for the administrative costs of preparing and submitting the request for federal approval to provide substance use disorder treatment and recovery services to Native Americans as provided for in section 25.5-5-314. All such gifts, grants, and donations must be transmitted to the state treasurer who shall credit the same to the Native American substance abuse treatment cash fund, which fund is created and referred to in this section as the fund. The money in the fund is subject to annual appropriation by the general assembly. All investment earnings derived from the deposit and investment of money in the fund remains in the fund and shall not be transferred or revert to the general fund of the state at the end of any fiscal year.
(2) Repealed.
Source: L. 2006: Entire article added with relocations, p. 1876, � 7, effective July 1. L. 2014: (2) repealed, (HB 14-1363), ch. 302, p. 1269, � 31, effective May 31. L. 2017: (1) amended, (SB 17-242), ch. 263, p. 1328, � 204, effective May 25. L. 2021: (1) amended, (HB 21-1021), ch. 256, p. 1511, � 7, effective September 7.
Editor's note: This section is similar to former � 26-4-423 as it existed prior to 2006.
Cross references: For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.
25.5-5-316. Legislative declaration - state department - disease management programs authorization - report. (1) The general assembly finds that, because Colorado is faced with rising health-care costs and limited resources, it is necessary to seek new ways to ensure the availability of high-quality, cost-efficient care for medicaid members. The general assembly further finds that disease management is a patient-focused, integrated approach to providing all components of care with attention to both quality of care and total cost. In addition, the general assembly finds that this approach may include coordination of physician care with pharmaceutical and institutional care. The general assembly further finds that disease management also addresses the various aspects of a disease state, including meeting the needs of persons who have multiple chronic illnesses. The general assembly declares that the improved coordination in disease management helps to provide chronically ill patients with access to the latest advances in treatment and teaches them how to be active participants in their health care through health education, thus reducing total health-care costs.
(2) The state department, in consultation with the department of public health and environment, is authorized to develop and implement disease management programs, for fee-for-service and primary care physician program recipients, that are designed to address over- or under-utilization or the inappropriate use of services or prescription drugs and that may affect the total cost of health-care utilization by a particular medicaid member with a particular disease or combination of diseases. The disease management programs shall target medicaid members who are receiving prescription drugs or services in an amount that exceeds guidelines outlined by the state department. The state department shall not restrict a medicaid member's access to the most cost-effective and medically appropriate prescription drugs or services. The state department may contract on a contingency basis for the development or implementation of the disease management programs authorized in this subsection (2).
(3) If the state department implements any disease management programs authorized in subsection (2) of this section, the state department shall report to the joint budget committee of the general assembly an estimate of the fiscal implications generated by the implementation of the disease management programs. Such report shall be made on or before February 1 of the year following the implementation of a disease management program and on or before each February 1 thereafter in which such program is in place.
Source: L. 2006: Entire article added with relocations, p. 1877, � 7, effective July 1. L. 2008: (2) amended, p. 800, � 2, effective May 14. L. 2024: (1) and (2) amended, (SB 24-176), ch. 152, p. 646, � 48, effective August 7.
Editor's note: This section is similar to former � 26-4-408.5 as it existed prior to 2006.
25.5-5-317. Obesity treatment pilot program - development and implementation - report - repeal. (Repealed)
Source: L. 2006: Entire article added with relocations, p. 1878, � 7, effective July 1.
Editor's note: (1) This section was similar to former � 26-4-534 as it existed prior to 2006.
(2) Subsection (4) provided for the repeal of this section, effective July 1, 2010. (See L. 2006, p. 1878.)