Title 25.5, Health Care Policy and Financing
0 chapters · 273 sections in this title.
Colo. Rev. Stat. § 25.5-5-502 Unused medications - reuse - rules - definition
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(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 s…
Colo. Rev. Stat. § 25.5-5-504 Providers of pharmaceutical services
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(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…
Colo. Rev. Stat. § 25.5-5-505 Prescribed drugs - mail order - rules
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(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…
Colo. Rev. Stat. § 25.5-5-506 Prescribed drugs - utilization review
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(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…
Colo. Rev. Stat. § 25.5-5-508 Electronic prescriptions - study - report - repeal. (Repealed)
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Source: L. 2009: Entire section added, (HB 09-1073), ch. 282, p. 1286, � 1, effective August 5. Editor's note: Subsection (4) provided for the repeal of this section, effective July 1, 2010. (See L. 2009, p. 1286.) 25.5-5-509. Substance use disorder - prescription drugs - opioid …
Colo. Rev. Stat. § 25.5-5-513 Pharmacy benefits - prescription drugs - rebates - analysis
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(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…
Colo. Rev. Stat. § 25.5-5-516 Serious mental illness - prescribed drugs
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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…
Colo. Rev. Stat. § 25.5-5-518 Coverage for choline dietary supplements - rules
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(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…
Colo. Rev. Stat. § 25.5-5-801 Legislative declaration
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(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…
Colo. Rev. Stat. § 25.5-5-802 Definitions
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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 mental …
Colo. Rev. Stat. § 25.5-5-804 Integrated funding pilot
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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 …
Colo. Rev. Stat. § 25.5-6-107 Financing of single entry point system - repeal. (Repealed)
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Source: L. 2006: Entire article added with relocations, p. 1917, � 7, effective July 1. L. 2021: (3) added by revision, (HB 21-1187), ch. 83, pp. 353, 354, �� 69, 70. L. 2024: IP(1), (1)(c)(II), and (2) amended, (SB 24-176), ch. 152, p. 663, � 73, effective August 7. Editor's not…
Colo. Rev. Stat. § 25.5-6-1101 Definitions
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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 inc…
Colo. Rev. Stat. § 25.5-6-1102 Service model - consumer-directed care
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(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 …
Colo. Rev. Stat. § 25.5-6-1103 Reporting
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(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…
Colo. Rev. Stat. § 25.5-6-115 Notification of federal immigration consequences
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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. …
Colo. Rev. Stat. § 25.5-6-118 Plan of care - rehabilitation therapy - requirements - definition
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(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 servi…
Colo. Rev. Stat. § 25.5-6-119 Long-term care for members with permanent disability
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(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…
Colo. Rev. Stat. § 25.5-6-1201 Legislative declaration - repeal. (Repealed)
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Source: L. 2006: Entire article added with relocations, p. 1970, � 7, effective July 1. L. 2014: Entire section amended, (HB 14-1358), ch. 255, p. 1017, � 2, effective August 6; entire section amended, (HB 14-1357), ch. 254, p. 1013, � 1, effective March 1, 2015. L. 2018: (2) ame…
Colo. Rev. Stat. § 25.5-6-1202 Definitions
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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) Authorized r…
Colo. Rev. Stat. § 25.5-6-1205 Accountability - rate structure - rules
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(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…
Colo. Rev. Stat. § 25.5-6-1206 Report - repeal. (Repealed)
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Source: L. 2006: Entire article added with relocations, p. 1973, � 7, effective July 1. L. 2011: Entire section amended, (SB 11-105), ch. 277, p. 1244, � 2, effective June 2. L. 2023: (2) added by revision, (SB 23-289), ch. 270, pp. 1610, 1611 �� 15, 19. Editor's note: (1) Prior …
Colo. Rev. Stat. § 25.5-6-1207 Repeal of part
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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. …
Colo. Rev. Stat. § 25.5-6-1208 Conditional repeal of part. (Repealed)
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Source: L. 2006: Entire article added with relocations, p. 1973, � 7, effective July 1. L. 2011: Entire section repealed, (SB 11-105), ch. 277, p. 1245, � 4, effective June 2; entire section repealed, (HB 11-1303), ch. 264, p. 1169, � 69, effective August 10. Editor's note: This …
Colo. Rev. Stat. § 25.5-6-1301 Legislative declaration
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(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…
Colo. Rev. Stat. § 25.5-6-1302 Definitions
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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 of …
Colo. Rev. Stat. § 25.5-6-1303 Complementary and integrative health - rules
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(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…
Colo. Rev. Stat. § 25.5-6-1304 Repeal of part
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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),…
Colo. Rev. Stat. § 25.5-6-1401 Legislative declaration
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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…
Colo. Rev. Stat. § 25.5-6-1402 Definitions
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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 consistent wi…
Colo. Rev. Stat. § 25.5-6-1403 Waivers and amendments
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(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…
Colo. Rev. Stat. § 25.5-6-1405 Rule-making authority
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(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…
Colo. Rev. Stat. § 25.5-6-1601 Definitions
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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 in se…
Colo. Rev. Stat. § 25.5-6-1605 Exemptions
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(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. …
Colo. Rev. Stat. § 25.5-6-1701 Legislative declaration
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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…
Colo. Rev. Stat. § 25.5-6-1702 Definitions
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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 utilizing …
Colo. Rev. Stat. § 25.5-6-1705 Person-centered support plan
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(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…
Colo. Rev. Stat. § 25.5-6-1707 Records and confidentiality of information
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(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.…
Colo. Rev. Stat. § 25.5-6-1709 Community-centered board designation - rules
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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…
Colo. Rev. Stat. § 25.5-6-1901 Definitions
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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 med…
Colo. Rev. Stat. § 25.5-6-1903 Permissible services and supports
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(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…
Colo. Rev. Stat. § 25.5-6-1904 Maintenance of effort
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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:…
Colo. Rev. Stat. § 25.5-6-1905 Eligibility
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(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…
Colo. Rev. Stat. § 25.5-6-201 Special definitions relating to nursing facility reimbursement
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As used in this part 2, unless the context otherwise requires: (1) Acquisition cost means the actual allowable cost to the owners of a capital-related asset or any improvement thereto as determined in accordance with generally accepted accounting principles. (2) Actual cost or co…
Colo. Rev. Stat. § 25.5-6-301 Short title
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This part 3 shall be known and may be cited as the Home- and Community-based Services for the Elderly, Blind, and Disabled Act. Source: L. 2006: Entire article added with relocations, p. 1937, � 7, effective July 1. Editor's note: This section is similar to former � 26-4-601 as i…
Colo. Rev. Stat. § 25.5-6-302 Legislative declaration
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The general assembly hereby finds and declares that it is the purpose of this part 3 to provide, under a federal waiver of statutory requirements, for an array of home- and community-based services to eligible elderly, blind, and disabled individuals as an alternative to nursing …
Colo. Rev. Stat. § 25.5-6-303 Definitions
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As used in this part 3, unless the context otherwise requires: (1) Adult day care facility means a facility which meets all applicable state and federal requirements and is certified by the state to provide adult day care services to eligible persons. (2) Adult day care services …
Colo. Rev. Stat. § 25.5-6-304 Administration
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The provisions of this part 3 shall be administered by the state department. Source: L. 2006: Entire article added with relocations, p. 1940, � 7, effective July 1. Editor's note: This section is similar to former � 26-4-604 as it existed prior to 2006. 25.5-6-305. Provision of s…
Colo. Rev. Stat. § 25.5-6-306 Eligible groups
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(1) Home- and community-based services under this part 3 shall be offered only to persons: (a) Who are elderly, blind, or physically disabled; and (b) Who are in need of the level of care available in a nursing home; and (c) Who are categorically eligible for medical assistance, …
Colo. Rev. Stat. § 25.5-6-307 Services for the elderly, blind, and disabled
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(1) Subject to the provisions of this part 3, home- and community-based services for the elderly, blind, and disabled include only the following services: (a) Adult day care; (b) Alternative care services; (c) (Deleted by amendment, L. 2023.) (d) Home modification services; (e) (…