As used in this part 4, unless the context otherwise requires:
(1) Case management agency has the same meaning as set forth in section 25.5-6-1702 (2).
(2) (a) Eligible person means a person with developmental disabilities:
(I) Who meets the definition of categorically needy as defined in section 25.5-4-103 (4);
(II) Who is in need of the level of care available in an intermediate care facility for individuals with intellectual disabilities;
(III) Whose gross income does not exceed three hundred percent of the current federal supplemental security income benefits level or other applicable standard provided in federal regulations construing the federal Social Security Act, as amended, and whose resources do not exceed the limit established for individuals receiving a mandatory minimum state supplementation of supplemental security income benefits or, in the case of a person who is married, do not exceed the amount authorized in section 25.5-6-101; and
(IV) For whom it is determined that provision of such services is necessary to avoid placement in an intermediate care facility for individuals with intellectual disabilities.
(b) The amount of parental income and resources that shall be attributable to a child's gross income for purposes of eligibility under paragraph (a) of this subsection (2) shall be set forth in rules promulgated by the state board of human services created in section 26-1-107, C.R.S.
(2.5) Entity has the same meaning as set forth in section 25.5-6-1702 (8).
(3) In-home services means those services described in section 25.5-10-205 provided to support persons living with their family.
(3.3) (a) Intellectual and developmental disability means a disability that manifests before the person reaches twenty-two years of age, that constitutes a substantial disability to the affected person, and that is attributable to an intellectual and developmental disability or related conditions, including Prader-Willi syndrome, cerebral palsy, epilepsy, autism, or other neurological conditions when those conditions result in impairment of general intellectual functioning or adaptive behavior similar to that of a person with an intellectual and developmental disability. Unless otherwise specifically stated, the federal definition of developmental disability found in 42 U.S.C. sec. 15002 (8) does not apply.
(b) Person with an intellectual and developmental disability or youth with an intellectual and developmental disability means a person or youth determined by a case management agency to have an intellectual and developmental disability and includes a child with a developmental delay.
(c) Child with a developmental delay means:
(I) A person less than five years of age with delayed development as defined by rule of the state board; or
(II) A person less than five years of age who is at risk of having an intellectual and developmental disability as defined by rule of the state board.
(4) Plan of care means a coordinated plan of care for provision of services in other than a nursing facility or institutional setting, developed and managed, subject to review and approval pursuant to section 25.5-6-404, by a case management agency for persons with intellectual and developmental disabilities. This plan of care shall fully identify the services to be provided to eligible persons. Prior to the provision of those services, a physician may be required to review an assessment document to ensure that it adequately describes the medical needs of the eligible person.
(5) (a) Services for persons with intellectual and developmental disabilities means those services:
(I) Approved for reimbursement by the federal government; and
(II) Necessary to prevent a person, eligible for services under subsection (2) of this section, from being subjected to placement in an intermediate care facility for individuals with intellectual disabilities.
(b) Services for persons with intellectual and developmental disabilities includes, but is not limited to, social, habilitative, remedial, residential, health services, and services provided under the consumer-directed care service model, part 11 of this article, which shall include the selection, from a list of qualified entities, of an organization of the eligible person's choice to provide financial management services for the eligible person.
Source: L. 2006: Entire article added with relocations, p. 1943, � 7, effective July 1. L. 2013: (2)(a)(II), (2)(a)(IV), and (5)(a)(II) amended, (SB 13-167), ch. 394, p. 2294, � 5, effective June 5; (1), (3), IP(5)(a), (5)(a)(II), and (5)(b) amended, (HB 13-1314), ch. 323, p. 1810, � 47, effective March 1, 2014. L. 2014: (3.3) added, (HB 14-1368), ch. 304, p. 1288, � 1, effective May 31. L. 2018: (1), (3.3)(a), and (3.3)(c)(II) amended, (SB 18-074), ch. 98, p. 770, � 2, effective August 8; (3.3)(a) amended, (SB 18-096), ch. 44, p. 474, � 15, effective August 8. L. 2019: (3.3)(a) amended, (SB 19-241), ch. 390, p. 3473, � 40, effective August 2. L. 2021: (1), (3.3)(b), and (4) amended and (2.5) added, (HB 21-1187), ch. 83, p. 334, � 31, effective July 1, 2024.
Editor's note: (1) This section is similar to former � 26-4-623 as it existed prior to 2006.
(2) Amendments to subsection (3.3)(a) by SB 18-074 and SB 18-096 were harmonized.
Cross references: (1) For additional definitions applicable to this part 4, see � 25.5-4-103.
(2) For the legislative declaration in SB 18-096, see section 1 of chapter 44, Session Laws of Colorado 2018.
25.5-6-404. Duties of the department of health care policy and financing and the department of human services. (1) The state department and the department of human services shall provide a system of reimbursement for services provided pursuant to this part 4 that encourages the most cost-effective provision of services.
(2) The state department and the department of human services shall, subject to appropriation, utilize any available federal, state, local, or private funds, including but not limited to, medicaid funds available under Title XIX of the federal Social Security Act, as amended, such as medicaid home- and community-based waivers, to carry out the purposes of this part 4.
(3) The state department may contract with the department of human services to certify agencies providing services under this part 4 as eligible medicaid providers, to adopt fiscal and administrative procedures, to review plans of care, to set rates, and to make and implement recommendations regarding the scope, duration, and content of programs and the eligibility of persons for specific services provided pursuant to this part 4, and to fulfill any other responsibilities necessary to implement this part 4 that are consistent with the single state agency designation set out in section 25.5-4-104.
(4) The executive director and the state board shall promulgate rules regarding this part 4 as necessary to fulfill the obligations of the state department as the single state agency to administer medical assistance programs in accordance with Title XIX of the federal Social Security Act, as amended. The rules may include, but are not limited to, determination of the level of care requirements for long-term care, patient payment requirements, members' rights, medicaid eligibility, and appeal rights associated with these requirements.
(5) The state board of human services, created in section 26-1-107, C.R.S., shall promulgate such rules as are necessary to implement the provisions of this part 4 and to fulfill the responsibilities and duties set out in article 10.5 of title 27, C.R.S. Such rules shall be promulgated pursuant to section 24-4-103, C.R.S.
(6) In the event that a direct conflict arises between the rules of the state department promulgated pursuant to subsection (4) of this section and the rules of the department of human services promulgated pursuant to subsection (5) of this section, regarding implementation of this part 4, the rules of the state department shall control.
Source: L. 2006: Entire article added with relocations, p. 1944, � 7, effective July 1. L. 2024: (4) amended, (SB 24-176), ch. 152, p. 666, � 83, effective August 7.
Editor's note: This section is similar to former � 26-4-624 as it existed prior to 2006.