(1) Costs associated with services provided by clinical pharmacists through a federally qualified health center, as defined in the federal Social Security Act, 42 U.S.C. sec. 1395x (aa)(4), are considered allowable costs for the purpose of a federally qualified health center's cost report and must be included in the calculation of the reimbursement rate for a patient visit at a federally qualified health center.
(2) (a) A federally qualified health center, as defined in the federal Social Security Act, 42 U.S.C. sec. 1395x (aa)(4), may establish a separate subsidiary company for the purpose of providing fee-for-service services outside of the federally qualified health center's standard cost report if:
(I) The subsidiary is providing fee-for-service services that have historically been provided and reimbursed on a fee-for-service basis; and
(II) The state department determines that the subsidiary's reimbursements would be budget neutral.
(b) Upon receiving any necessary federal authorization, the state department shall reimburse a subsidiary company, as described in subsection (2)(a) of this section, on a fee-for-service basis for services that are eligible for fee-for-service reimbursement.
(c) A subsidiary that receives reimbursement pursuant to this section may pass through money received from the reimbursement directly to the federally qualified health center operating as the subsidiary's parent corporation.
(d) (I) The state department shall exclude all costs associated with a subsidiary company established pursuant to this subsection (2) from the calculation of a federally qualified health center's reimbursement rates.
(II) The state department shall require a federally qualified health center that establishes a separate subsidiary company pursuant to this subsection (2) to include the costs associated with the subsidiary in its cost report that is necessary to calculate reimbursement rates.
(3) The state department shall promulgate rules to implement the provisions of this section.
Source: L. 2021: Entire section added, (HB 21-1275), ch. 470, p. 3379, � 2, effective September 7. L. 2025: Entire section amended, (HB 25-1288), ch. 260, p. 1332, � 3, effective May 27.
Cross references: For the legislative declaration in HB 25-1288, see section 1 of chapter 260, Session Laws of Colorado 2025.
25.5-5-332. Therapy using equine movement - federal authorization - definition. (1) Subject to federal authorization and federal financial participation, on or after July 1, 2024, therapy using equine movement may be provided by a physical therapist licensed pursuant to article 285 of title 12, an occupational therapist licensed pursuant to article 270 of title 12, or a speech-language pathologist certified pursuant to article 305 of title 12.
(2) As used in this section, unless the context otherwise requires, therapy using equine movement means therapeutic activities that leverage horse-human interactions to facilitate progression toward meeting therapeutic goals.
Source: L. 2022: Entire section added, (HB 22-1068), ch. 311, p. 2229, � 2, effective June 2.
Cross references: For the legislative declaration in HB 22-1068, see section 1 of chapter 311, Session Laws of Colorado 2022.
25.5-5-333. Primary care and behavioral health statewide integration grant program - creation - report - definition - repeal. (1) As used in this section, unless the context otherwise requires, grant program means the primary care and behavioral health statewide integration grant program created in subsection (2) of this section.
(2) There is created in the state department the primary care and behavioral health statewide integration grant program to provide grants to physical and behavioral health-care providers for implementation of evidence-based clinical integration care models, as defined by the state department, in collaboration with the behavioral health administration in the department of human services.
(3) (a) Grant recipients may use the money received through the grant program for the following purposes:
(I) Developing infrastructure for primary care, pediatric, and behavioral health-care providers to better serve individuals with behavioral health needs in outpatient health-care settings;
(II) Increasing access to quality health care for individuals with behavioral health needs;
(III) Investing in early interventions for children, youth, and adults that reduce escalation and exacerbation of behavioral health conditions;
(IV) Addressing the need to expand the behavioral health-care workforce;
(V) Developing and implementing alternative payment models, including the development of protocols, processes, work flow, and partnerships; and
(VI) Training primary care providers in trauma-informed care, adverse childhood experiences, and trauma recovery.
(b) Any money received through the grant program must supplement and not supplant existing health-care services. Grant recipients shall not use money received through the grant program for:
(I) Ongoing or existing executive and senior staff salaries;
(II) Services already covered by medicaid or a member's other insurance; or
(III) Ongoing or existing electronic health records costs.
(c) (I) (A) If a grant recipient is a hospital-owned or hospital-affiliated practice that is not part of a hospital system and has less than ten percent total profit as measured by state department transparency reporting, the grant recipient shall provide a twenty-five percent match for the awarded amount. The grant recipient may use community benefit funds, in-kind personnel time, or federal relief funding for the twenty-five percent match required pursuant to this subsection (3)(c)(I)(A).
(B) If a grant recipient is a hospital-owned or hospital-affiliated practice that is part of a hospital system or has ten percent or more total profit as measured by state department transparency reporting, the grant recipient shall provide a fifty percent match for the awarded amount. The grant recipient may use community benefit funds, in-kind personnel time, or federal relief funding for the fifty percent match required pursuant to this subsection (3)(c)(I)(B).
(C) If a grant recipient is a critical access hospital, as defined in section 10-16-1303 (2), the grant recipient shall provide a ten percent match for the awarded amount. The grant recipient may use community benefit funds, in-kind personnel time, or federal relief funding for the ten percent match required pursuant to this subsection (3)(c)(I)(C).
(II) For the purposes of this subsection (3)(c), hospital-affiliated means there is a contractual relationship between a hospital or an entity that is owned by or under common ownership and control with the hospital in which the contractual relationship enables the hospital or entity that is owned by or under common ownership and control with the hospital to exercise control over one of the following entities:
(A) Another hospital;
(B) An entity owned by or under common ownership and control with another hospital; or
(C) A physician group practice.
(d) The state department may provide funding to physical and behavioral health-care providers through infrastructure building and population-based payment mechanisms.
(e) Grant recipients shall participate in technical assistance education and training and related workgroups as determined by the state department.
(4) (a) The state department shall administer the grant program and, subject to available appropriations, shall award grants as provided in this section. Subject to available appropriations, grants shall be paid out of the behavioral and mental health cash fund created in section 24-75-230.
(b) In order to support real-time transformation and access to care, the state department shall ensure timely payment to grant recipients for services related to the grant program.
(5) Grant applicants shall demonstrate a commitment to maintaining models and programs that, at a minimum:
(a) Measurably increase access to behavioral health screening, referral, treatment, and recovery care;
(b) Implement or expand evidence-based models for integration that improve patient health as evidenced by relevant and meaningful outcomes measures, including patient-reported outcomes;
(c) Leverage multidisciplinary treatment teams;
(d) Serve publicly funded consumers;
(e) Maintain a plan for how to address a member with emergency needs;
(f) Maintain a plan for how technology will be leveraged for whole-person care, which may include plans for data security, electronic health records reforms, care management platforms, and telehealth implementation or expansion; and
(g) Implement or engage in state-department-specified tools and shared learning and resources, including but not limited to:
(I) Peer learning collaboratives to develop sustainable population-based payment models led by the state department;
(II) Use of electronic tools for screening, measurement-based care management, and referrals; and
(III) Data-sharing best practices.
(6) In selecting grant recipients, the state department shall first prioritize applicants that serve priority populations that experience disparities in health-care access and outcomes, including but not limited to historically marginalized and underserved communities, determined by the communities with the highest proportion of patients receiving assistance through the Colorado Medical Assistance Act, this article 5 and articles 4 and 6 of this title 25.5. The state department shall then prioritize applicants that meet as many of the following criteria as possible:
(a) Serve individuals with co-occurring and complex care needs, serious mental illnesses, or disabilities;
(b) Serve children and youth;
(c) Include opportunities to build out community health worker, behavioral health aide, or similar programs, supported by population-based payments;
(d) Serve pregnant and postpartum people;
(e) The practice is considered a small and independent practice;
(f) Demonstrate the ability and intent to serve culturally diverse populations and populations with limited English proficiency;
(g) Include workforce capacity-building components;
(h) Include high-intensity outpatient services;
(i) Improve data exchange and data integration that supports whole-person care;
(j) Utilize telehealth;
(k) Align with or participate in commercial alternative payment models;
(l) Demonstrate community partnerships; or
(m) Participate in the regional health connector program created in section 25-20.5-2001.
(7) (a) The state department shall establish a set of statewide resources to support grant recipients. At a minimum, the resources must include:
(I) A clinical consultation and practice transformation support team provided by the Colorado health extension system in the practice innovation program; and
(II) A sustainable billing and data partnership team that will train and support grant recipients in meeting standards and core competencies for alternative payment models, transforming the primary care providers' payment systems to focus on integrative, whole-person care, and creating and implementing data-sharing practices and policies that support mental health disorders, substance use disorders, and co-occurring disorders.
(b) The state department may enter into interagency agreements or procure contracts to establish the resources pursuant to this subsection (7).
(8) The state department may procure a grant application and support team to assist the state department with drafting the grant application, reviewing applications, and administering and processing grant awards.
(9) A grant recipient must spend or obligate any money received pursuant to this section in accordance with section 24-75-226 (4)(d).
(10) (a) The state department shall establish a steering committee to:
(I) Provide continuous input into grant application requirements;
(II) Provide feedback and direction on data collection standards and review; and
(III) Engage with community partners who will help support the integrated care practices through referrals and trusted communications.
(b) The state department shall select a state department employee to chair the steering committee, staff the steering committee, and reimburse any participant who is not a state employee for reasonable travel expenses.
(11) The state department shall, in collaboration with the behavioral health administration and the division of insurance, prepare a report that includes recommendations on best practices for sustaining integrated care models. In preparing the report, the state department shall collect data from each grant recipient related to clinical quality improvement and access to care. Grant recipients shall provide data to the state department in a timely manner, as determined by the state department. The state department is authorized to recoup or discontinue grant funding for grant recipients that do not comply with the data reporting requirements or grant standards set by the state department.
(12) The state department and any person who receives money from the state department pursuant to this section shall comply with the compliance, reporting, record-keeping, and program evaluation requirements established by the office of state planning and budgeting and the state controller in accordance with section 24-75-226 (5).
(13) This section is repealed, effective July 1, 2027.
Source: L. 2022: Entire section added, (HB 22-1302), ch. 180, p. 1195, � 2, effective May 18; (9) amended, (HB 22-1411), ch. 271, p. 1960, � 15, effective May 27. L. 2023: IP(6) and (6)(m) amended, (HB 23-1244), ch. 436, p. 2570, � 5, effective August 7. L. 2024: (3)(b)(II), (5)(d), and (5)(e) amended, (SB 24-176), ch. 152, p. 651, � 54, effective August 7.
Cross references: For the legislative declaration in HB 22-1302, see section 1 of chapter 180, Session Laws of Colorado 2022. For the legislative declaration in HB 23-1244, see section 1 of chapter 436, Session Laws of Colorado 2023.
25.5-5-334. Community health worker services - federal authorization - reporting - rules - definition. (1) As used in this section, unless the context otherwise requires, community health worker means a frontline public health worker who serves as a liaison between health-care providers or social service providers and community members in order to facilitate access to physical, behavioral, or dental health-related services, or services to address social determinants of health, and who improves the quality and cultural responsiveness of health-related service delivery.
(2) No later than July 1, 2024, the state department shall seek federal authorization from the federal centers for medicare and medicaid services to provide reimbursement for community health worker services including, but not limited to, the delivery of preventive services, group and individual health education and health coaching, health navigation, transitions of care supports, screening and assessment for nonclinical and social needs, and individual support and health advocacy.
(3) Prior to seeking federal authorization, the state department shall hold at least four public stakeholder meetings to facilitate public engagement and solicit input from relevant stakeholders on the development of the required elements for federal authorization. Relevant stakeholders include, but are not limited to, community health workers, representatives from a statewide group representing community health workers, consumer advocates, local public health agencies, public health nonprofits and institutes, representatives from Colorado department of public health and environment-recognized training programs for health navigators and community health workers, health-care providers, managed care entities, representatives from schools and school-based health centers, and the Colorado department of public health and environment. At a minimum, the state department shall seek input from stakeholders regarding:
(a) Ways to ensure community health workers serve to reduce health disparities and increase health equity;
(b) Minimum qualifications for community health workers, such as training and skills-based experience requirements;
(c) Methods for minimizing the burden of entering into the community health workforce;
(d) A patient safety monitoring responsibilities and grievance process;
(e) What services provided by a community health worker will be considered covered services and noncovered services;
(f) Processes and requirements regarding provider types, provider enrollment, billing codes, places of service, and any other operational component necessary for implementation in the medicaid management information system;
(g) Reimbursement using the fee-for-service managed care or values-based payment models for community health workers with consideration of the use of alternative payment methodologies in the future;
(h) New provider types that could facilitate community health worker services outside of traditional health-care settings, such as community-based organizations; and
(i) Clarification on community health workers' role and scope of practice as part of a delivery system that may include case management, care management, and care coordination services provided by managed care entities, community-centered boards, single entry points, behavioral health administrative service organizations, case management agencies, and health-care providers.
(4) In consideration of opportunities for future expansion of the community health worker workforce, the Colorado department of public health and environment is encouraged to partner with the state department and stakeholders to make recommendations for training and competency standards related to specialization that would enable community health workers to specialize their work with different populations and health conditions.
(5) Costs associated with services provided by community health workers through a federally qualified health center, as defined in the federal Social Security Act, 42 U.S.C. sec. 1395x (aa)(4), are considered allowable costs for the purposes of a federally qualified health center's cost report. The state department shall work with stakeholders to determine how services provided by community health workers will be captured in federally qualified health centers' cost reports.
(6) Costs associated with services provided by community health workers through a rural health clinic, as defined in the federal Social Security Act, 42 U.S.C. sec. 1395x (aa)(2), are considered allowable costs for the purposes of a rural health clinic's cost report. The state department shall work with stakeholders to determine how services provided by community health workers will be captured in rural health centers' cost reports.
(7) The state department shall consult with the Colorado department of public health and environment in promulgating rules concerning the voluntary competency-based community health worker registry managed by the Colorado department of public health and environment and any additional criteria or standards that may be necessary.
(8) For purposes of medicaid reimbursement, a community health worker shall:
(a) Work under the supervision of a clinician or within a licensed or otherwise approved and medicaid-enrolled health provider agency; and
(b) Meet the minimum qualifications and credentialing requirements of the voluntary competency-based community health worker registry as defined in section 25-20.5-112.
(9) The state department shall ensure that reimbursement policies and federal authorities for existing unlicensed health workers, such as peer support professionals, recovery professionals, managed care navigation staff, and others, are aligned and incorporated with the community health worker payment models.
(10) On or before January 31, 2027, the state department shall report on ways community health workers are being utilized through the state medical assistance program and include available data or any identified costs or savings associated with community health worker services and considerations for the general assembly to expand community health worker services in community-based organizations that are outside of the traditional health-care setting in its presentation to the joint budget committee of the general assembly and in its presentation to the health and human services committee of the senate and the health and insurance committee of the house of representatives, or any successor committees, at the SMART Act hearing held pursuant to section 2-7-203.
(11) Subject to available appropriations, upon receiving any necessary federal authorization, beginning January 1, 2026, the state department shall reimburse community health workers who comply with the requirements of subsection (8) of this section.
Source: L. 2023: Entire section added, (SB 23-002), ch. 157, p. 679, � 2, effective August 7. L. 2024: (2) amended, (HB 24-1450), ch. 490, p. 3420, � 63, effective August 7. L. 2025: (10) amended and (11) added, (SB 25-229), ch. 220, p. 1011, � 1, effective May 20.
Cross references: For the legislative declaration in SB 23-002, see section 1 of chapter 157, Session Laws of Colorado 2023.
25.5-5-335. Continuous medical coverage for children and adults feasibility study - federal authorization - rules - report - definition. (1) The state department shall study the feasibility of extending continuous medical coverage for additional children and adults and how to better meet the health-related social needs of medical assistance program members.
(2) At a minimum, the feasibility study must consider the costs; implementation factors, including county workload, training, and administrative burdens on the counties, information technology systems, upgrades, and associated costs; potential health benefits for individuals and communities, including disadvantaged and marginalized groups; impacts of increased use of preventive and high-value health services; administrative savings, including, but not limited to, reducing or eliminating eligibility processing for populations during the continuous eligibility period; reductions in administrative turnover and coverage loss; and, to the extent practicable, social and economic impacts with respect to the following:
(a) Allowing an eligible child, as defined in this article 5 and articles 2, 3, 6, and 8 of this title 25.5, including children eligible under sections 25.5-2-104 and 25.5-2-105, to remain continuously eligible for medical assistance and the children's basic health plan for twenty-four months after the last day of the month in which the child was enrolled;
(b) Allowing an eligible child, as defined in this article 5 and articles 2, 3, 6, and 8 of this title 25.5, including children eligible under sections 25.5-2-104 and 25.5-2-105 who are less than six years of age, to remain continuously eligible for medical assistance or the children's basic health plan without regard to a change in household income until the child reaches six years of age;
(c) Allowing an eligible adult to remain continuously eligible for medical assistance without regard to income for twelve months and twenty-four months after the last day of the month in which the adult was enrolled. For purposes of this subsection (2)(c), an eligible adult includes a person eighteen years of age or older who:
(I) Has an income under thirty-three percent of the federal poverty line;
(II) Is experiencing homelessness; or
(III) Has been in community corrections, is on parole, or has been released from another carceral setting, including jail or federal prison. For purposes of this subsection (2)(c)(III), continuous eligibility starts on the individual's medicaid approval date.
(d) Allowing an adult who is eligible for medical assistance at the time of enrollment to remain continuously eligible for medical assistance without regard to income for twelve months after the last day of the month in which the adult was enrolled.
(3) In addition to the study topics detailed in subsection (2) of this section, the feasibility study must study how to best meet the health-related social needs of medical assistance program members who are historically disadvantaged and underserved and must give consideration to concerns related to housing and food security.
(4) In conducting the feasibility study pursuant to this section, the state department shall take into consideration the efforts of other states to improve the health-related social needs of medical assistance program members, including, but not limited to, housing and nutritional needs, initiatives to pay for rental housing assistance for up to six months, the needs of perinatal members, youth in or transitioning out of foster care, former foster care youth, people with substance use disorders, high-risk infants and children, and the needs of low-income individuals impacted by natural disasters, and the state department shall seek input from relevant stakeholders. In conducting the stakeholder process, the state department shall:
(a) Engage directly with:
(I) Impacted individuals who are enrolled in medical assistance or the children's basic health plan and whose coverage, or whose children's coverage, would be extended if legislation were passed to extend continuous medical coverage for individuals pursuant to subsections (2)(a) to (2)(d) of this section;
(II) Service providers, particularly those whose patients are predominantly medical assistance program members or are uninsured;
(III) Advocacy organizations;
(IV) Counties;
(V) Organizations that assist with enrollment into the medical assistance programs and the Colorado health exchange; and
(VI) Individuals working in or representing communities that are diverse with regard to race, ethnicity, immigration status, age, ability, sexual orientation, gender identity, or geographic region of the state and are affected by higher rates of health disparities and inequities;
(b) Publicly conduct stakeholder meetings, report on the outcomes of the meetings, and publicize the reports in English as well as two other commonly spoken languages in Colorado;
(c) Include opportunities for participation in the stakeholder process outside of regular work hours; and
(d) Hold at least three stakeholder meetings.
(5) On or before January 1, 2026, the state department shall submit a report detailing the findings and recommendations from the feasibility study to the joint budget committee of the senate and the house of representatives, or its successor committee, the governor, and to the house of representatives public and behavioral health and human services committee and the senate health and human services committee, or any successor committees. The state department shall also make the report available to the public on the state department's website.
(6) Nothing in this section prohibits or limits the state department's ability to amend any approved federal authorization or to seek other federal permissions necessary to expand continuous eligibility coverage to additional populations prior to the completion of the feasibility study described in this section.
(7) (a) No later than April 1, 2024, the state department shall seek federal authorization from the federal centers for medicare and medicaid services to provide continuous medical coverage for eligible children and eligible adults described in subsections (7)(b) and (7)(c) of this section, and to continue enrollment for individuals with no income, as described in subsection (7)(d) of this section.
(b) For purposes of seeking federal authorization pursuant to subsection (7)(a) of this section, an eligible child is as defined in this article 5 and articles 2, 3, 6, and 8 of this title 25.5, including a child eligible pursuant to sections 25.5-2-104 and 25.5-2-105, and must be under three years of age. An eligible child shall remain continuously eligible without regard to household income until the eligible child reaches three years of age; except that a child is no longer eligible and must be disenrolled from a medical assistance program if the state department becomes aware that the child has moved out of the state, the state department or county possesses facts indicating that the family has requested the child's voluntary disenrollment, the state department determines eligibility was erroneously granted, or the child is deceased.
(c) For purposes of seeking federal authorization pursuant to subsection (7)(a) of this section, an eligible adult is limited to an adult who has been released from a Colorado department of corrections facility after serving a sentence. An eligible adult shall remain continuously eligible for medical assistance without regard to income for a period of twelve months beginning on the date of the eligible adult's release; except that an adult is no longer eligible and must be disenrolled from the medical assistance program if the state department becomes aware that the adult has moved out of the state, the state department or county possesses facts indicating that the adult has requested voluntary disenrollment, the state department determines eligibility was erroneously granted, or the adult is deceased.
(d) To facilitate the renewal process for the medical assistance program for individuals with no income, including those who are experiencing homelessness, the state department shall seek federal authorization, to the extent allowable by the federal centers for medicare and medicaid services, to complete the income determination for ex parte renewals without requesting additional income information or documentation, if:
(I) An attestation of zero-dollar income was verified within the last twelve months at the initial application or the previous renewal; and
(II) The state department has checked financial data sources in accordance with its eligibility verification plan as required by the federal centers for medicare and medicaid services and no information is received.
(e) Upon approval of the federal authorization sought pursuant to this subsection (7), the state department shall implement the continuous eligibility coverage requirements pursuant to this subsection (7) by January 1, 2026. In implementing the continuous eligibility requirements of this section, the state department shall take all necessary steps to relieve the obligation of the state department and counties to promptly evaluate information that does not affect eligibility for continuous coverage cases under this section, unless required for program administration or as approved by the federal authorization.
(f) The continuous eligibility sought pursuant to this subsection (7) is dependent on the receipt of federal financial participation, to the maximum extent allowed under federal law, through federal authorization, state plan amendment, or otherwise, by the federal centers for medicare and medicaid services.
(g) The state board may promulgate rules as necessary to implement the requirements of this section.
Source: L. 2023: Entire section added, (HB 23-1300), ch. 302, p. 1810, � 2, effective June 1. L. 2024: (1), (3), IP(4), and (4)(a)(II) amended, (SB 24-176), ch. 152, p. 651, � 55, effective August 7; IP(7)(d) and (7)(d)(II) amended, (HB 24-1450), ch. 490, p. 3421, � 64, effective August 7.
Cross references: For the legislative declaration in HB 23-1300, see section 1 of chapter 302, Session Laws of Colorado 2023.
25.5-5-336. Prohibition on using the body mass index or ideal body weight - medical necessity criteria. (1) (a) Beginning July 1, 2023, the state medical assistance program shall not utilize the body mass index, ideal body weight, or any other standard requiring an achieved weight when determining medical necessity or the appropriate level of care for an individual diagnosed with an eating disorder, including but not limited to, bulimia nervosa, atypical anorexia nervosa, binge-eating disorder, avoidant restrictive food intake disorder, and other specified feeding and eating disorders as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.
(b) Subsection (1)(a) of this section does not apply when determining medical necessity or the appropriate level of care for an individual diagnosed with anorexia nervosa, restricting subtype; however, body mass index, ideal body weight, or any other standard requiring an achieved body weight must not be the determining factor when assessing medical necessity or the appropriate level of care for an individual diagnosed with anorexia nervosa, restricting subtype.
(2) The following factors, at a minimum, must be considered when determining medical necessity or the appropriate level of care for an individual diagnosed with an eating disorder:
(a) The individual's eating behaviors;
(b) The individual's need for supervised meals and support interventions;
(c) Laboratory results, including but not limited to, the individual's heart rate, renal or cardiovascular activity, and blood pressure;
(d) The recovery environment; and
(e) Co-occurring disorders the individual may have.
Source: L. 2023: Entire section added, (SB 23-176), ch. 275, p. 1626, � 2, effective May 30.
25.5-5-337. Telehealth remote monitoring services for outpatient clinical services - grant program - federal authorization - rules - definitions. (1) As used in this section, unless the context otherwise requires:
(a) Grant program means the telehealth remote monitoring grant program created in subsection (6) of this section.
(b) Member means any person who has been determined eligible to receive benefits or services under this title 25.5.
(c) Telehealth remote monitoring means the ongoing remote assessment and monitoring of clinical data through technological equipment in order to detect changes in a member's clinical status, which allows health-care providers to intervene before a health condition exacerbates and requires emergency intervention or inpatient hospitalization.
(2) (a) On or before September 1, 2024, the state department shall initiate a stakeholder process to determine the billing structure for telehealth remote monitoring for outpatient clinical services.
(b) The state department stakeholder process, required by subsection (2)(a) of this section, must engage with health-care providers who serve rural and underserved populations, including rural health clinics and federally qualified health centers, to ensure the billing structure is sustainable in these health-care settings.
(c) On or before June 30, 2025, the state board shall promulgate rules regarding the billing structure based on feedback from the stakeholder process required in subsections (2)(a) and (2)(b) of this section.
(3) (a) Beginning July 1, 2025, the state department shall provide reimbursement for the use of telehealth remote monitoring for outpatient clinical services if:
(I) The member's health-care provider determines that telehealth remote monitoring is medically necessary based on the member's medical condition or status;
(II) The member's health-care provider determines that telehealth remote monitoring would likely prevent the member's admission or readmission to a hospital, emergency department, nursing facility, or other clinical setting;
(III) The member is cognitively and physically capable of operating the telehealth remote monitoring device or equipment or the member has a caregiver who is able and willing to assist with the telehealth remote monitoring device or equipment; and
(IV) The member resides in a setting that is suitable for telehealth remote monitoring and does not have health-care staff on site.
(b) The state board shall promulgate rules regarding additional eligibility requirements. The eligibility requirements must prioritize members with chronic conditions and members who are pregnant and carrying a high-risk pregnancy.
(4) The assessment and monitoring of the health data transmitted by telehealth remote monitoring must be performed by one of the following licensed health-care professionals:
(a) Physician;
(b) Podiatrist;
(c) Advanced practice registered nurse;
(d) Physician assistant;
(e) Respiratory therapist;
(f) Pharmacist; or
(g) Licensed health-care professional working under the supervision of a medical director.
(5) The state department may seek any federal authorization necessary to implement subsections (3) and (4) of this section.
(6) (a) There is created in the state department the telehealth remote monitoring grant program to provide grants to outpatient health-care facilities located in a designated rural county or a designated health-care professional shortage area to assist the hospitals and clinics with the financial costs associated with providing telehealth remote monitoring for outpatient clinical services.
(b) The state department shall administer the grant program and, subject to available appropriations, shall award grants as provided in this subsection (6).
(c) To be eligible for a grant, an outpatient health-care facility must:
(I) Apply for a grant in the manner prescribed by the state department;
(II) Be located in a designated rural county or designated health-care professional shortage area; and
(III) Have a demonstrated need for financial assistance to purchase equipment to provide telehealth remote monitoring for outpatient clinical services.
(d) The state department may award up to five grants through the grant program. Each grant awarded must be in the amount of one hundred thousand dollars.
(e) In selecting grant recipients, the state department shall prioritize applicants that serve populations experiencing disparities in health-care access and outcomes, including, but not limited to, historically marginalized and underserved communities, determined by the communities with the highest proportion of patients receiving assistance through the Colorado Medical Assistance Act, this article 5 and articles 4 and 6 of this title 25.5.
(f) Grant recipients may use money received through the grant program to implement telehealth remote monitoring for outpatient clinical services and includes the following:
(I) Training staff to use, assess, and monitor telehealth remote monitoring equipment and devices; and
(II) Acquiring telehealth remote monitoring equipment and devices.
(g) Money allocated to the grant program must not be considered in rate-setting for federally qualified health centers, as defined in the federal Social Security Act, 42 U.S.C. sec. 1395x (aa)(4).
(7) The state department is authorized to receive and expend gifts, grants, and donations from individuals, private organizations, foundations, or any governmental unit; except that no gift, grant, or donation may be accepted by the state department if it is subject to a condition that is inconsistent with this section or any other law of this state.
(8) This section does not apply to home health-care benefits provided pursuant to section 25.5-5-321.
Source: L. 2024: Entire section added, (SB 24-168), ch. 281, p. 1875, � 2, effective August 7.
Cross references: For the legislative declaration in SB 24-168, see section 1 of chapter 281, Session Laws of Colorado 2024.
25.5-5-338. Continuous glucose monitors - coverage - federal authorization - definition. (1) As used in this section, unless the context otherwise requires, continuous glucose monitor means an instrument or a device designed for the purpose of aiding in the treatment of diabetes by measuring glucose levels on demand or at set intervals through a small electronic sensor that slightly penetrates an individual's skin when applied and that is designed to remain in place and active for at least seven days.
(2) (a) Beginning November 1, 2025, the state department shall provide coverage for a continuous glucose monitor and related supplies to members under the medicaid medical and pharmacy benefit.
(b) Coverage criteria must align with the current glucose monitor local coverage determination standards issued by the centers for medicare and medicaid that are used to determine coverage for medicare-eligible individuals, including individuals with gestational diabetes not being treated with insulin.
(3) Coverage pursuant to this section includes the cost of any necessary repairs or replacement parts for the continuous glucose monitor.
(4) The state department may seek any federal authorization necessary to implement this section.
(5) The state department is authorized to receive and expend gifts, grants, and donations from individuals, private organizations, foundations, or any governmental unit; except that no gift, grant, or donation may be accepted by the state department if it is subject to a condition that is inconsistent with this section or any other law of this state.
Source: L. 2024: Entire section added, (SB 24-168), ch. 281, p. 1878, � 3, effective August 7.
Cross references: For the legislative declaration in SB 24-168, see section 1 of chapter 281, Session Laws of Colorado 2024.
25.5-5-339. Coverage for services addressing health-related social needs feasibility study - federal authorization - report - rules. (1) (a) The state department shall study the feasibility of providing nutrition, housing, and tenant supportive services that address members' health-related social needs in order to determine whether to seek a federal authorization to provide the services.
(b) The feasibility study must address the costs, implementation factors, affected populations, federal and state funding mechanisms, and timeline for the state department to seek a federal authorization that, at a minimum, provides:
(I) Housing-related services and tenant supportive services, including up to six months of rental assistance or temporary housing and utility assistance, where applicable, for:
(A) Individuals transitioning out of institutional care or a congregate care setting, or individuals at risk of institutionalization;
(B) Individuals who are experiencing homelessness, at risk of homelessness, or transitioning out of an emergency shelter, noncongregate shelter, or micro-community; and
(C) Youth in or transitioning out of foster care, or former foster care youth; and
(II) Nutrition-related services, including up to three medically tailored meals per day, initially for up to six months with the possibility of continuing the meals upon a state department determination to continue the meals, delivered to a member's home or other private residence if the member has an eligible health-related medical or health-related social need, as determined by the state department.
(c) The feasibility study must also address the costs, implementation factors, timeline, provider types, settings, and full range of services to be covered for the state department to seek a federal authorization that provides:
(I) Pre-tenancy and tenancy-sustaining services, including, but not limited to, tenant rights education and eviction prevention;
(II) Housing transition navigation services, including, but not limited to, individualized case management, skills building, and peer support services;
(III) One-time housing transition and moving costs, including, but not limited to, security deposits; first month's rent; movers; relocation expenses; and costs associated with utility activation, identification requirements, and housing applications and inspections;
(IV) Pantry stocking or up to three meals per day, delivered to the member's home or other private residence for a child or youth under twenty-one years of age or a pregnant person for up to six months; and
(V) Nutrition prescriptions that are targeted to medically vulnerable populations, as determined by the state department, and tailored to the member's health and social risk, nutrition-sensitive health conditions, or have a demonstrated outcome improvement, including fruit and vegetable prescriptions and protein boxes for up to six months.
(2) In addition to the study topics detailed in subsection (1) of this section, the feasibility study must address how to best:
(a) Ensure the housing-related services and tenant supportive services described in subsection (1) of this section supplement and integrate with other existing housing-related services and tenant supportive services;
(b) Coordinate eligibility and priority determinations for the housing-related services and tenant supportive services described in subsection (1) of this section with existing processes, including wait lists and coordinated entry systems;
(c) Align temporary housing assistance described in subsection (1)(b)(I) of this section with existing long-term rental assistance program requirements and processes;
(d) Ensure the nutrition-related services described in subsection (1) of this section supplement rather than supplant existing federal, state, and local nutrition-related services;
(e) Coordinate with state agencies and county departments to connect members experiencing food insecurity to other state and federal nutrition programs, including the federal special supplemental food program for women, infants, and children, 42 U.S.C. sec. 1786, as amended; the supplemental nutrition assistance program, established in part 3 of article 2 of title 26; and temporary assistance for needy families, as defined in section 26-2-703;
(f) Coordinate with other state and local housing authorities to assist members in obtaining other existing housing-related services and tenant supportive services;
(g) Ensure that all health-related social needs services provided pursuant to subsection (1) of this section are:
(I) Medically appropriate, as determined by state-defined clinical and social risk criteria; and
(II) Optional for members, who may opt out at any time; and
(h) Utilize managed care entities, as defined in section 25.5-5-403, to coordinate services that address the health-related social needs of members described in subsection (1) of this section.
(3) (a) In conducting the feasibility study pursuant to this section, the state department shall determine:
(I) What provider types may be reimbursed for housing-related services and tenant supportive services, which must not be limited to clinical providers;
(II) The types of housing-related services and tenant supportive services, including supportive or wraparound services, that are required to keep people stably housed and that are available for reimbursement, including, but not limited to, case management, on-site physical and behavioral health care, peer support services, skill-building services, and navigation services; and
(III) The housing settings in which housing-related services and tenant supportive services may be provided, including, but not limited to, traditional congregate shelters, noncongregate shelters, and micro-communities, where people are transitionally housed.
(b) In determining the reimbursement methodology for housing-related services and tenant supportive services pursuant to subsection (3)(a) of this section, the state department shall consider a per member per month lump sum payment combined with housing vouchers and other available subsidies rather than a direct reimbursement model.
(c) In conducting the feasibility study pursuant to this section, the state department shall consider how best to leverage available state-designated health program funding.
(4) In conducting the feasibility study pursuant to this section, the state department shall take into consideration examples of federal authorizations granted to other states in order to streamline the development of a potential federal authorization for health-related social needs in Colorado and increase the likelihood of its approval.
(5) If, in conducting the feasibility study pursuant to this section, the state department determines that providing nutrition, housing, and tenant supportive services that address members' health-related social needs through federal authorization would be budget neutral to the general fund due to offsetting reductions in medical services expenditures or other state expenditures, then the state department shall seek federal authorization no later than July 1, 2025, to provide any of the nutrition, housing, and tenant supportive services described in this section.
(6) On or before November 10, 2024, the state department shall submit a report detailing the findings and recommendations from the feasibility study to the joint budget committee. If the determination to seek federal authorization is made pursuant to subsection (5) of this section, the state department shall notify the joint budget committee in the state department's report of the state department's intent to seek federal authorization pursuant to subsection (5) of this section. The state department shall also notify the joint budget committee of the cost of nutrition, housing, and tenant supportive services that address members' health-related social needs through federal authorization if the state department determines that nutrition, housing, and tenant supportive services that address members' health-related social needs would not be budget neutral.
(7) The state department may hire a consultant to assist with developing the feasibility study and related report; the process of seeking federal authorization; and any resulting monitoring, renewal, or amendment processes.
(8) The state department may seek, accept, and expend gifts, grants, or donations from private or public sources for the purposes of conducting the feasibility study pursuant to this section.
(9) The state board shall promulgate any rules necessary to implement and administer this section.
(10) The state department shall continue to cover the costs of current housing-related and tenant supportive services through the statewide supportive services expansion pilot program until federal authorization is granted.
(11) To provide peer support services in compliance with the terms of the federal authorization, the state department shall develop a workforce to provide peer support services.
Source: L. 2024: Entire section added, (HB 24-1322), ch. 362, p. 2449, � 1, effective June 3. L. 2025: (12) added, (SB 25-308), ch. 299, p. 1524, � 2, effective May 30.
Editor's note: (1) This section was numbered as � 25.5-5-338 in HB 24-1322 but was renumbered on revision for ease of location.
(2) Subsection (11) was numbered as subsection (12) in SB 25-308 but was renumbered on revision for ease of location.
25.5-5-340. Health-related social needs reinvestment cash fund - creation - definitions. (1) As used in this section, unless the context otherwise requires:
(a) Federal authorization means the authorization the state department received from the federal centers for medicare and medicaid services to provide coverage for health-related social needs through the state medical assistance program.
(b) Fund means the health-related social needs reinvestment cash fund created in this section.
(2) (a) The health-related social needs reinvestment cash fund is created in the state treasury. The fund consists of money transferred to the fund pursuant to subsection (3) of this section and any other money that the general assembly may appropriate or transfer to the fund.
(b) In accordance with section 24-36-114 (1), the state treasurer shall credit all interest and income derived from the deposit and investment of money in the fund to the general fund.
(3) Beginning June 30, 2026, and on June 30 of each year thereafter, the state treasurer shall transfer from the general fund to the fund an amount of money equal to the amount of unspent money that reverted to the general fund in that year from the appropriation from the general fund to the state department for health-related social needs.
(4) Subject to annual appropriation by the general assembly, the state department may expend money from the fund for services that support health-related social needs and related administrative services, as authorized by the federal authorization.
(5) On or after November 1, 2025, and on or after November 1 each year thereafter, the state department shall present to the joint budget committee a recommendation for spending money in the fund to expand and enhance services authorized by the federal authorization. When developing the recommendation, the state department shall consult with state agencies participating in services provided through, and stakeholders who represent the members receiving services included in, the federal authorization.
Source: L. 2025: Entire section added, (SB 25-308), ch. 299, p. 1523, � 1, effective May 30.