Title 25.5, Health Care Policy and Financing

(1) The general assembly hereby declares that: (a) A large number of Coloradans are in need of long-term health care; (b) The cost of long-term care, especially nursing home care, is significant; (c) Many persons in need of long-term care are ineligible for state medical assistan…

As used in this part 11, unless the context otherwise requires: (1) "Attendant support" means any action to assist an eligible person in accomplishing activities of daily living, instrumental activities of daily living, and habilitative and health-related tasks. Such activities i…

(1) The state department shall implement a consumer-directed care service model that allows eligible persons to receive a direct payment through a voucher to purchase qualified services. The state department is authorized to seek any federal waivers or waiver amendments that may …

(1) The state department shall provide a report to the joint budget committee of the general assembly and the health and human services committees of the house of representatives and the senate, or any successor committees, by October 1, 2006, that includes, but is not limited to…

(1) (a) The general assembly finds and declares that: (I) The state demography office in the department of local affairs estimates that between 2005 and 2015, the portion of Colorado's population that is over sixty-five years of age will increase by more than twenty-three percent…

The state department shall consult with stakeholders, including people with lived experience, immigrants rights advocates, health-care advocates, and immigration lawyers, to provide clear and accurate information and referrals regarding current public charge policies. Source: L. …

(1) As used in this section, unless the context otherwise requires, "professional medical information document" means documented medical information signed by a licensed medical professional and used as a component of the functional assessment for long-term services and supports …

(1) As used in the section, unless the context otherwise requires, "plan of care" has the same meaning as set forth in section 25.5-6-403. (2) The state department shall not impose signature requirements beyond what is required by the federal centers for medicare and medicaid ser…

(1) For a member receiving services through a long-term care program pursuant to parts 3 to 10 of this article 6, if a service the member receives is discontinued or is no longer a covered service, the state department must confirm the timeline for continuity of treatment with th…

(1) As used in this section, unless the context otherwise requires, "direct care service cost to administrative cost ratio" means the percentage of medicaid services revenue that a home- and community-based service provider agency that renders base wage qualifying services spends…

As used in this part 12, unless the context otherwise requires: (1) "Attendant" means a person who is directly employed by an in-home support service agency to provide, or a family member, including a spouse, providing, in-home support services to eligible persons. (2) "Authorize…

(1) The state department shall offer in-home support services as an option for eligible persons who receive community first choice services. In-home support services must be provided to eligible persons. The state department shall seek any federal authorization that may be necess…

(1) The provision of the in-home support services set forth in this part 12 shall be subject to the availability of federal matching medicaid funds, pursuant to Title XIX of the federal "Social Security Act", as amended, for payment of the costs for administration and the costs f…

(1) The state department shall develop the accountability requirements necessary to safeguard the use of public dollars and to promote effective and efficient service delivery under this part 12. (2) The state board, by rule, shall set a separate rate structure for in-home suppor…

This part 12 is repealed, effective September 1, 2028. Prior to such repeal, in-home support services established under this part 12 shall be reviewed as provided for in section 24-34-104. Source: L. 2006: Entire article added with relocations, p. 1973, § 7, effective July 1. L. …

(1) The general assembly finds that: (a) A person living with a spinal cord injury, multiple sclerosis, a brain injury, spina bifida, muscular dystrophy, or cerebral palsy could benefit from complementary and integrative health such as chiropractic care, massage therapy, or acupu…

As used in this part 13, unless the context otherwise requires: (1) "Complementary or integrative health" means a form of diverse health-care services not provided for under this article 6 or article 4 or 5 of this title 25.5 prior to August 5, 2009, but authorized by the rules o…

(1) (a) The general assembly authorizes the state department to continue operations of a program that would allow an eligible person with a disability to receive complementary or integrative health to the extent authorized by federal waiver. The state department may seek any fede…

This part 13 is repealed, effective September 1, 2030. Source: L. 2009: Entire part added, (HB 09-1047), ch. 395, p. 2130, § 1, effective August 5. L. 2015: Entire section amended, (SB 15-011), ch. 333, p. 1356, § 4, effective June 5. L. 2019: Entire section amended, (SB 19-197),…

The general assembly hereby declares its support for the full employment of people with disabilities. It is the general assembly's intent to enact this part 14 for the purpose of allowing an individual with disabilities to purchase medicaid coverage that will enable the individua…

As used in this part 14, unless the context otherwise requires: (1) "Basic coverage group" means the category of eligibility under the federal "Ticket to Work and Work Incentives Improvement Act of 1999", Pub.L. 106-170, that provides an opportunity to buy into medicaid consisten…

(1) Repealed. (2) If approved by the joint budget committee and subject to available appropriations, the state department shall submit to the federal centers for medicare and medicaid services an amendment to the state medical assistance plan, and shall request any necessary waiv…

(1) Eligibility. An individual is eligible for and shall receive medicaid provided in this part 14 through a medicaid buy-in program without losing eligibility for medicaid if all of the following conditions are met: (a) The individual meets the requirements for the basic coverag…

(1) The state board shall promulgate rules necessary to implement and administer the medicaid buy-in program created in this part 14, including, in consultation with the Colorado healthcare affordability and sustainability enterprise created in section 25.5-4-402.4 (3)(a), the es…

Notwithstanding any other provision of law, this part 14 shall be implemented only if, and to the extent that, the state department determines that federal financial participation is available under the medicaid program. Source: L. 2008: Entire part added, p. 2200, § 1, effective…

(1) The general assembly finds and declares that: (a) Federally required assessments indicate that more persons living in institutional settings expressed an interest in transitioning to home- or community-based settings than currently have transitions available to them; (b) Fede…

As used in this part 16, unless the context otherwise requires: (1) "Compensation" has the meaning set forth in section 25.5-6-406 (2)(b)(I). (2) "Health maintenance activities" has the meaning set forth in section 25.5-6-1901 (2). (3) "Home care agency" has the meaning set forth…

(1) Not more than ninety days after May 28, 2019, the state department shall request from the federal government an increase of eight and one-tenth percent in the reimbursement rate for the following services delivered to members through the home- and community-based services wai…

(1) This section applies to each home care agency that receives reimbursement pursuant to the "Colorado Medical Assistance Act" for the provision of personal care services, homemaker services, or in-home support services. (2) (a) On and after July 1, 2025, the hourly minimum wage…

(1) On or before January 1, 2020, the state department and the department of public health and environment, in consultation with stakeholders, shall establish a process for reviewing and enforcing initial and ongoing training requirements for persons who provide personal care ser…

(1) Notwithstanding any provision of this part 16 to the contrary, this part 16 does not apply to services provided under: (a) The consumer-directed attendant support services model; or (b) The pediatric personal care benefit. Source: L. 2019: Entire part added, (SB 19-238), ch. …

The general assembly finds and declares that there is a need to ensure a high-performing statewide case management system exists that serves all populations of people who qualify for long-term services and supports. The case management system includes, but is not limited to, inta…

As used in this part 17, unless the context otherwise requires: (1) "Authorized representative" means a person designated by the member receiving services, or by the parent or guardian of the member receiving services, if appropriate, to assist the member in acquiring or utilizin…

(1) No later than July 1, 2024, the state board shall adopt rules providing for the establishment of a case management system that consists of case management agencies throughout the state for the purpose of enabling individuals in need of long-term care to access appropriate lon…

(1) Intellectual and developmental disability determination. Any person may request an evaluation to determine whether the person has a developmental delay or an intellectual and developmental disability and is eligible to receive long-term services and supports pursuant to this …

(1) Each member receiving services shall have a person-centered support plan, or a similar plan specified by the state department, developed and managed by a case management agency or an entity, and subject to review and approval pursuant to section 25.5-6-404. The person-centere…

(1) A member receiving long-term services and supports pursuant to this article 6 or article 10 of this title 25.5 must be terminated from long-term services and supports upon a determination, made pursuant to the person-centered support planning process, that the long-term servi…

(1) A record for each member receiving services must be diligently maintained by the case management agency or the entity. The record must include, but not be limited to, information pertaining to the determination of eligibility for services and the person-centered support plan.…

(1) The state auditor may conduct or cause to be conducted a performance audit that includes each case management agency or each entity that receives more than seventy-five percent of its funding on an annual basis from the federal, the state, or a local government or from any co…

The state department shall develop a process to designate local or regional organizations as community-centered boards. The state department shall promulgate rules outlining the designation process no later than July 1, 2024. Any contracts or agreements entered into pursuant to t…

As used in this part 19, unless the context otherwise requires: (1) "Electronic monitoring" means the installation, purchase, or rental of electronic monitoring devices that enable an individual to secure help in the event of an emergency; provide the individual reminders about m…

(1) No later than July 1, 2025, the state department shall seek federal authorization through an amendment to the state medical assistance plan to implement the community first choice option. (2) At a minimum, the state plan amendment must provide for, but is not limited to: (a) …

(1) The state department may provide permissible services and supports that are linked to an assessed need or goal in the individual's person-centered service plan. Permissible services and supports may include, but are not limited to, the following: (a) Expenditures for transiti…

In implementing the community first choice option, the state department shall ensure continuity of support for eligible individuals who were receiving services as of July 1, 2025, and who have maintained eligibility in the state medical assistance program since that date. Source:…

(1) To be eligible for the community first choice option, an individual must: (a) Be eligible for the state medical assistance program; (b) Be in an eligibility group under the state medical assistance program that includes nursing facility services, or if in an eligibility group…

(1) No later than July 1, 2024, the state department, in collaboration with the behavioral health administration, and the department of human services pursuant to article 64.5 of title 27, shall begin developing a system of care for children and youth who have complex behavioral …