Title 25.5, Health Care Policy and Financing
0 chapters · 273 sections in this title.
Colo. Rev. Stat. § 25.5-4-101 Short title
0.3K chars
This article and articles 5 and 6 of this title shall be known and may be cited as the Colorado Medical Assistance Act. Source: L. 2006: Entire article added with relocations, p. 1815, � 7, effective July 1. Editor's note: This section is similar to former � 26-4-101 as it existe…
Colo. Rev. Stat. § 25.5-4-102 Legislative declaration
1.0K chars
It is the purpose of the Colorado Medical Assistance Act to promote the public health and welfare of the people of Colorado by providing, in cooperation with the federal government, medical and remedial care and services for individuals and families whose income and resources are…
Colo. Rev. Stat. § 25.5-4-103 Definitions
15.8K chars
As used in this article 4 and articles 5 and 6 of this title 25.5, unless the context otherwise requires: (1) Repealed. (1.5) Accountable care collaborative means a medicaid care delivery system established pursuant to section 25.5-5-419. (2) Applicant means an individual who is …
Colo. Rev. Stat. § 25.5-4-104 State medical assistance program - single state agency
2.0K chars
(1) The state department, by rules, shall establish a program of medical assistance to provide necessary medical care for the categorically needy. The state department is designated as the single state agency to administer the medical assistance program in accordance with Title X…
Colo. Rev. Stat. § 25.5-4-105 Federal requirements under Title XIX
4.5K chars
Nothing in this article or articles 5 and 6 of this title shall prevent the state department from complying with federal requirements for a program of medical assistance in order for the state of Colorado to qualify for federal funds under Title XIX of the social security act and…
Colo. Rev. Stat. § 25.5-4-107 Retaliation definition
1.7K chars
(1) For purposes of any rules promulgated by the state department or state board and any action taken by the state department against any person, retaliation means taking any of the following actions against a member or someone acting on behalf of a member after the member or som…
Colo. Rev. Stat. § 25.5-4-203 Advisory council established
2.2K chars
(1) There is created the state medical assistance and services advisory council, referred to in this article 4 as the advisory council, consisting of sixteen members, as follows: (a) The executive director of the state department and the executive director of the department of pu…
Colo. Rev. Stat. § 25.5-4-204 Automated medical assistance administration
20.5K chars
(1) The general assembly hereby finds and declares that the agency responsible for the administration of the state's medical assistance program would be more effective in its ability to streamline administrative functions of program administrators and providers under the program …
Colo. Rev. Stat. § 25.5-4-205.5 Confined persons - suspension of benefits
2.1K chars
(1) For purposes of this section, unless the context otherwise requires, confined person means a person who is: (a) An inmate confined to a correctional institution operated by or under contract with the department of corrections; (b) Confined in a jail; (c) Committed to a juveni…
Colo. Rev. Stat. § 25.5-4-206 Reimbursement to counties - costs of administration
0.4K chars
The state department shall reimburse the county departments for costs of administration incurred by the counties under this article and articles 5 and 6 of this title in accordance with the provisions of section 26-1-122 (5), C.R.S. Source: L. 2006: Entire article added with relo…
Colo. Rev. Stat. § 25.5-4-207 Appeals - rules - applicability
7.3K chars
(1) (a) (I) If an application for medical assistance is not acted upon within a reasonable time after filing the application, or if an application is denied in whole or in part, or if medical assistance benefits are suspended, terminated, or modified, the applicant or member may …
Colo. Rev. Stat. § 25.5-4-208 County duties - transitional medicaid
11.3K chars
County departments shall assist families in completing the reporting requirements for transitional medicaid. This shall include informing families of the transitional medicaid eligibility requirements and the required reporting calendar. Source: L. 2006: Entire article added with…
Colo. Rev. Stat. § 25.5-4-210 Purchase of health insurance for members
10.1K chars
(1) (a) The state department shall purchase group health insurance for a medical assistance member who is eligible to enroll for coverage if enrollment of the member in the group plan would be cost-effective. In addition, the state department may purchase individual health insura…
Colo. Rev. Stat. § 25.5-4-213 Audit of medicaid member correspondence - definition
4.5K chars
(1) As used in this section, unless the context otherwise requires, member correspondence has the same meaning as defined in section 25.5-4-212. (2) During the 2020 calendar year and the 2023 calendar year, the office of the state auditor shall conduct or cause to be conducted a …
Colo. Rev. Stat. § 25.5-4-300.4 Last resort for payment - legislative intent
0.4K chars
It is the intent of the general assembly that medicaid is the last resort for payment for medically necessary goods and services furnished to members and that all other sources of payment are primary to medical assistance provided by medicaid. Source: L. 2008: Entire section adde…
Colo. Rev. Stat. § 25.5-4-300.7 Prevention of coding errors - prepayment review of claims
71.1K chars
(1) The state department shall implement and maintain a system for reducing medical services coding errors in medicaid claims submitted to the state department for reimbursement. The system shall include automatic, prepayment review of medicaid claims through the use of nationall…
Colo. Rev. Stat. § 25.5-4-302 Recovery of assets
6.5K chars
(1) The general assembly finds, determines, and declares that the cost of providing medical assistance to qualified members throughout the state has increased significantly in recent years; that such increasing costs have created an increased burden on state revenues while reduci…
Colo. Rev. Stat. § 25.5-4-303.3 Provider fraud - attorney general report
1.1K chars
(1) No later than October 1, 2017, and no later than October 1 each year thereafter, the attorney general shall submit a written report to the state department for inclusion in a single, comprehensive report to the general assembly concerning medicaid fraud pursuant to section 25…
Colo. Rev. Stat. § 25.5-4-303.5 Short title
0.3K chars
This section and sections 25.5-4-304 to 25.5-4-310 shall be known and may be cited as the Colorado Medicaid False Claims Act. Source: L. 2010: Entire section added, (SB 10-167), ch. 296, p. 1379, � 10, effective May 26. Cross references: For the legislative declaration in SB 10-1…
Colo. Rev. Stat. § 25.5-4-304 Definitions
2.4K chars
As used in sections 25.5-4-303.5 to 25.5-4-309, unless the context otherwise requires: (1) (a) Claim means a request or demand for money or property, whether under a contract or otherwise, and regardless of whether the state has title to the money or property, under the Colorado …
Colo. Rev. Stat. § 25.5-4-305 False medicaid claims - liability for certain acts
4.1K chars
(1) Except as otherwise provided in subsection (2) of this section, a person is liable to the state for a civil penalty of not less than five thousand five hundred dollars and not more than eleven thousand dollars; except that these upper and lower limits on liability shall autom…
Colo. Rev. Stat. § 25.5-4-306 Civil actions for false medicaid claims
13.4K chars
(1) Responsibility of attorney general. The attorney general shall diligently investigate a violation under section 25.5-4-305. If the attorney general finds that a person has violated or is violating section 25.5-4-305, the attorney general may bring a civil action under this se…
Colo. Rev. Stat. § 25.5-4-307 False medicaid claims procedures - statute of limitations
2.3K chars
(1) A civil action under section 25.5-4-306 (1) or (2) may not be brought after the later of: (a) More than six years after the date on which the violation of section 25.5-4-305 is committed; or (b) More than three years after the date when facts material to the right of action a…
Colo. Rev. Stat. § 25.5-4-308 False medicaid claims jurisdiction
0.6K chars
An action under section 25.5-4-306 may be brought in any judicial district in which the defendant or, in the case of multiple defendants, any one defendant can be found, resides, or transacts business or in which an act proscribed by section 25.5-4-305 occurred. A summons as requ…
Colo. Rev. Stat. § 25.5-4-309 False medicaid claims civil investigation demands
30.9K chars
(1) General. (a) (I) Whenever the attorney general has reason to believe that a person may be in possession, custody, or control of documentary material or information relevant to a false medicaid claims law investigation, the attorney general may, before commencing a civil proce…
Colo. Rev. Stat. § 25.5-4-310 Medicaid false claims report
1.8K chars
(1) Notwithstanding section 24-1-136 (11)(a)(I), on or before January 15, 2012, and on or before each January 15 thereafter, the attorney general shall submit a written report to the health and human services committees of the senate and the house of representatives, or any succe…
Colo. Rev. Stat. § 25.5-4-401 Providers - payments - rules
6.7K chars
(1) (a) The state department shall establish rules for the payment of providers under this article 4 and articles 5 and 6 of this title 25.5. Within the limits of available funds, the rules must provide reasonable compensation to providers, but no provider, by this section or any…
Colo. Rev. Stat. § 25.5-4-401.2 Performance-based payments - reporting
112.3K chars
(1) To improve health outcomes and lower health-care costs, the state department may develop payments to providers that are based on quantifiable performance or measures of quality of care. These performance-based payments may include, but are not limited to, payments to: (a) Pri…
Colo. Rev. Stat. § 25.5-4-402.5 Providers - state university teaching hospitals
28.0K chars
Subject to appropriations by the general assembly, the state department shall make payments to state university teaching hospitals for providing care under the state's medical assistance program established pursuant to this article and articles 5 and 6 of this title. Source: L. 2…
Colo. Rev. Stat. § 25.5-4-404 Payments for clinic services - restrictions on use
0.7K chars
All payments received by county or district public health agencies or boards of health for clinic services, as defined in section 25.5-5-301 (3), furnished to patients shall be used only to offset costs incurred for provision of services by such county or district public health a…
Colo. Rev. Stat. § 25.5-4-405 Mental health managed care service providers - requirements
4.1K chars
(1) Each contract between the state department and a managed care organization providing mental health services to a member under the medical assistance program must comply with all federal requirements, including but not limited to: (a) Ensuring that a member with complex or mul…
Colo. Rev. Stat. § 25.5-4-407 Services by licensed psychologists without a doctor's referral
5.9K chars
The executive director of the state department may authorize the providing of services of licensed psychologists without the requirement that the services be referred by a doctor of medicine or a doctor of osteopathy, but such services shall be subject to the cost containment pro…
Colo. Rev. Stat. § 25.5-4-411 Authorization of services provided by dental hygienists
13.1K chars
(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…
Colo. Rev. Stat. § 25.5-4-415 No public funds for abortion - exception - definitions - repeal
5.1K chars
[Editor's note: This version of this section is effective until January 1, 2026.] (1) It is the purpose of this section to implement the provisions of section 50 of article V of the Colorado constitution, adopted by the registered electors of the state of Colorado at the general …
Colo. Rev. Stat. § 25.5-4-416 Providers - medical equipment and supplies - requirements
14.2K chars
(1) As used in this section, unless the context otherwise requires, provider means a person or entity that delivers disposable medical supplies or durable medical equipment products or services directly to a member. (2) On and after January 1, 2007, the state board rules for the …
Colo. Rev. Stat. § 25.5-4-423 Targets for investments in primary care
2.1K chars
The state department shall adopt appropriate targets for investments in primary care to support value-based health-care delivery in alignment with the affordability standards developed in accordance with section 10-16-107 (3.5). The state department shall consider the recommendat…
Colo. Rev. Stat. § 25.5-4-427 State payment to the Denver health and hospital authority
8.6K chars
(1) The state department shall distribute money appropriated for a payment to the Denver health and hospital authority created in section 25-29-103. (2) (Deleted by amendment, L. 2024.) Source: L. 2023: Entire section added, (SB 23-138), ch. 4, p. 13, � 2, effective March 3. L. 2…
Colo. Rev. Stat. § 25.5-4-433 Rural hospital cash fund - creation - definition
2.3K chars
(1) The rural hospital cash fund is created in the state treasury and is referred to in this section as the fund. The fund consists of money credited to the fund and any other money that the general assembly may appropriate or transfer to the fund. (2) The state treasurer shall c…
Colo. Rev. Stat. § 25.5-4-435 Reimbursement for sixty-day stay
0.3K chars
The state department shall reimburse an institution for mental diseases, as defined in 42 CFR 435.1010, for providing inpatient mental health treatment to a member for up to sixty days or to the extent permitted by federal law. Source: L. 2025: Entire section added, (SB 25-042), …
Colo. Rev. Stat. § 25.5-4-502 Federal authorization - repeal. (Repealed)
0.3K chars
Source: L. 2006: Entire article added with relocations, p. 1853, � 7, effective July 1. Editor's note: (1) This section was similar to former � 25.5-1-113 as it existed prior to 2006. (2) Subsection (3) provided for the repeal of this section, effective July 1, 2007. (See L. 2006…
Colo. Rev. Stat. § 25.5-4-503 Waiver applications - authorization
1.8K chars
(1) The state department is authorized to apply for health insurance flexibility and accountability waivers that will enable the state to add more flexibility to Colorado's medicaid program and that will result in a cost-effective method of providing health-care services to Color…
Colo. Rev. Stat. § 25.5-4-504 Federal authorization - repeal. (Repealed)
16.7K chars
Source: L. 2019: Entire section added, (SB 19-222), ch. 226, p. 2265, � 3, effective May 20. Editor's note: Subsection (3) provided for the repeal of this section, effective July 1, 2020. (See L. 2019, p. 2265.) Cross references: For the legislative declaration in SB 19-222, see …