Title 25.5, Health Care Policy and Financing

(1) Repealed. (2) The state department of human services, in conjunction with the state department, shall continue its existing efforts, which include obtaining and considering member input, to develop managed care systems for the developmentally disabled population and to consid…

(1) (a) The general assembly hereby finds and declares that it is the intent of this section to replicate the ON LOK program in San Francisco, California, that has proven to be cost-effective at both the state and federal levels. The PACE program is part of a national replication…

(1) It is the intent of the general assembly to recognize the practice of telemedicine as a legitimate means by which an individual may receive medical services from a health-care provider without person-to-person contact with a provider. (2) Repealed. (3) On or after January 1, …

(1) (a) The general assembly finds that: (I) Increasing health-care costs in Colorado's medicaid program creates challenges for the state's budget. Further, the increasing health-care costs do not necessarily reflect improvements in either health outcomes for patients or in patie…

(1) In 2011, the state department created the accountable care collaborative, also referred to in this title 25.5 as the medicaid coordinated care system. The state department shall continue to provide care delivery through the accountable care collaborative. The goals of the acc…

Within one hundred twenty days of the enactment of the federal "Advancing Care for Exceptional Kids Act", subject to available appropriations, the state department shall seek any federal approval necessary to fund, in cooperation with hospitals that meet the specified requirement…

(1) The state department shall require each MCE contracted with the state department to disclose all necessary information in order for the state department, by June 1, 2020, and by each June 1 thereafter, to submit a report to the health and insurance committee and the public he…

(1) As used in this section, "FDA" means the food and drug administration in the United States department of health and human services. (2) Notwithstanding any provision of law to the contrary, each MCE that provides prescription drug benefits or methadone administration for the …

No later than July 1, 2023, the state department shall contract with one or more independent review organizations to conduct external medical reviews requested for review by a medicaid provider when there is a denial or reduction for residential or inpatient substance use disorde…

(1) On or before October 1, 2021, the state department shall consult with the behavioral health administration in the department of human services, residential treatment providers, and MCEs to develop standardized utilization management processes to determine medical necessity fo…

(1) No later than July 1, 2022, the state department shall contract with an independent third-party vendor to audit thirty-three percent of all denials of authorization for inpatient and residential substance use disorder treatment for each MCE. (2) Beginning no later than Januar…

(1) The state department shall require each MCE that contracts with the state department to disclose the aggregated average and lowest rates of reimbursement for a set of behavioral health services determined by the state department. (2) Behavioral health providers are authorized…

(1) The state department shall include in each new contract with, or renewal of a contract with, an MCE a provision requiring the MCE to submit to the state department, on an annual basis, the amount the MCE is paid for delivering services and the MCE's medical loss ratio. (2) Th…

The state department shall publish on the state department's website an easily accessible list of secure transportation providers, as defined in section 27-65-102, that have contracts with managed care entities. The list must include the contact information for the secure transpo…

As a condition of doing business in the state, each provider is deemed to authorize the state department, or an independent contractor retained by the state department, to bill a third party, as defined in section 25.5-4-209 (2)(g)(II), on behalf of the provider if the third part…

(1) (a) As to drugs for which payment is made, the state board's rules for payment must include the requirement that the generic equivalent of a brand-name drug be prescribed if the generic equivalent is a therapeutic equivalent to the brand-name drug, except when reimbursement t…

(1) As used in this section, unless the context otherwise requires, "medication" means prescription medication that is not a controlled substance. (2) A pharmacist participating in the medical assistance program may accept unused medication from a licensed facility, as defined in…

(1) The state department is authorized to ensure the participation of Colorado medical assistance members who are also eligible for medicare in any federal prescription drug benefit enacted for medicare recipients. (2) Prescribed drugs are not a covered benefit under the medical …

(1) Consistent with the provisions of section 25.5-4-401 (1) and subsections (2) and (3) of this section, and subject to available appropriations, no provider of pharmaceutical services who meets the conditions imposed by this article 5 and articles 4 and 6 of this title 25.5 and…

(1) (a) (I) The state board shall adopt by rule a system to allow medical assistance recipients the option to receive through the mail prescribed maintenance medications used to treat chronic medical conditions. (II) The state board rules must include the definition of maintenanc…

(1) The state department shall develop and implement a drug utilization review process to assure the appropriate utilization of drugs by patients receiving medical assistance in the fee-for-service and primary care physician programs. The review process shall include the monitori…

There is hereby created the prescription drug information and technical assistance program. The program shall provide advice on the prudent use of prescription drugs to persons who receive prescription drug benefits pursuant to this part 5. The state department shall contract wit…

(1) Notwithstanding any provisions of this part 5 to the contrary, for the treatment of a substance use disorder, in promulgating rules, and subject to any necessary federal authorization, the state board shall authorize reimbursement for at least one federal food and drug admini…

A pharmacy administering injectable antagonist medication for medication-assisted treatment for substance use disorders shall receive an enhanced dispensing fee that aligns with the administration fee paid to a provider in a clinical setting. Source: L. 2018: Entire section added…

(1) (a) The general assembly finds and declares that: (I) Pharmacists are highly trained and educated doctorate-level health-care professionals specializing in the effective use of medications and their outcomes; (II) Pharmacists provide health care throughout the entire health-c…

(1) (a) The general assembly finds and declares that: (I) It is estimated that over one million Coloradans experience a mental health or substance use disorder each year, yet less than half of the adult population in this state receives the care it needs; (II) It is well document…

(1) As used in this section, unless the context otherwise requires, "medications for opioid use disorder" or "MOUD" has the meaning as set forth in section 12-280-103 (27.5). (2) The state department shall reimburse a licensed pharmacist for prescribing or administering medicatio…

(1) Beginning in 2023, the state department shall, in collaboration with the administrator of the all-payer health claims database described in section 25.5-1-204, conduct an annual analysis of the prescription drug rebates received in the previous calendar year, by health insura…

(1) As used in this section, "HIV" means human immunodeficiency virus. (2) (a) Before July 1, 2027, the state department shall not restrict by prior authorization or step therapy requirements any prescription drug approved by the federal food and drug administration that is used …

(1) (a) The general assembly finds and declares that: (I) Pharmacists are highly trained and educated, doctorate-level health-care professionals specializing in the effective use of medications and their outcomes; (II) Pharmacists provide health care throughout the entire health-…

Notwithstanding any provisions of this part 5 to the contrary, and subject to any necessary federal authorization, the state board shall require a review for coverage of a new drug approved by the federal food and drug administration for a serious mental illness within ninety day…

(1) As used in this section, unless the context otherwise requires: (a) "Mental health disorder or mental health condition" refers to the mental health disorders described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. (b) "Prescription d…

(1) No later than July 1, 2025, the state board shall promulgate rules to include coverage under the medical assistance program for over-the-counter choline dietary supplements for pregnant persons. (2) The state department shall seek federal approval, as necessary, for the cover…

(1) As used in this section, unless the context otherwise requires: (a) "Infusion pharmacy" means a prescription drug outlet that prepares and dispenses a solution that includes parenteral nutrition for direct administration into a patient's bloodstream. The solution may contain …

(1) The general assembly finds and declares that: (a) In order to provide quality behavioral health services to families of children and youth with behavioral health challenges, behavioral health services should be coordinated among state departments and political subdivisions of…

As used in this part 8, unless the context otherwise requires: (1) "At risk of out-of-home placement" means a child or youth who is eligible for medical assistance pursuant to articles 4, 5, and 6 of this title 25.5 and the child or youth: (a) Has been diagnosed as having a menta…

(1) Subject to available appropriations, the state department shall seek federal authorization from the federal centers for medicare and medicaid services to provide wraparound services for eligible children and youth who are at risk of out-of-home placement or in an out-of-home …

Subject to available appropriations, the state department, in conjunction with the behavioral health administration in the department of human services, counties, and other relevant departments, shall design and recommend a child and youth behavioral health delivery system pilot …