Title 25.5, Health Care Policy and Financing
0 chapters · 273 sections in this title.
Colo. Rev. Stat. § 25.5-3-201 Short title. (Repealed)
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Source: L. 2006: Entire article amended with relocations, p. 1809, � 6, effective July 1. L. 2011: Entire section repealed, (SB 11-216), ch. 149, p. 520, � 4, effective May 5.
Colo. Rev. Stat. § 25.5-3-202 Legislative declaration. (Repealed)
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Source: L. 2006: Entire article amended with relocations, p. 1809, � 6, effective July 1. L. 2010: (3) amended, (HB 10-1422), ch. 419, p. 2109, � 139, effective August 11. L. 2011: Entire section repealed, (SB 11-216), ch. 149, p. 520, � 4, effective May 5.
Colo. Rev. Stat. § 25.5-3-203 Definitions. (Repealed)
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Source: L. 2006: Entire article amended with relocations, p. 1810, � 6, effective July 1. L. 2010: (7)(a) amended, (HB 10-1422), ch. 419, p. 2109, � 140, effective August 11. L. 2011: Entire section repealed, (SB 11-216), ch. 149, p. 520, � 4, effective May 5. 25.5-3-204. Compreh…
Colo. Rev. Stat. § 25.5-3-205 Grant-making process. (Repealed)
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Source: L. 2006: Entire article amended with relocations, p. 1811, � 6, effective July 1. L. 2011: Entire section repealed, (SB 11-216), ch. 149, p. 520, � 4, effective May 5.
Colo. Rev. Stat. § 25.5-3-206 Reports. (Repealed)
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Source: L. 2006: Entire article amended with relocations, p. 1812, � 6, effective July 1. L. 2011: Entire section repealed, (SB 11-216), ch. 149, p. 520, � 4, effective May 5. 25.5-3-207. Program funding - comprehensive primary and preventive care fund - creation - repeal. (Repea…
Colo. Rev. Stat. § 25.5-3-301 Definitions
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As used in this part 3, unless the context otherwise requires: (1) Comprehensive primary care means the basic, entry-level health care provided by health-care practitioners or non-physician health-care practitioners that is generally provided in an outpatient setting. Comprehensi…
Colo. Rev. Stat. § 25.5-3-303 Consultation
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At least annually, the state department shall consult with representatives of federally qualified health centers, school-based health centers, family residency directors, certified rural health clinics, other qualified providers, and consumer advocates regarding the implementatio…
Colo. Rev. Stat. § 25.5-3-304 Primary care fund report
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(1) Beginning February 1, 2026, and each February 1 thereafter, the executive director shall prepare and submit an annual report to the house of representatives health and human services committee and the senate health and human services committee, or their successor committees; …
Colo. Rev. Stat. § 25.5-3-401 Short title
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This part 4 is known as and may be cited as the Colorado Dental Health Care Program for Low-income Seniors. Source: L. 2014: Entire part added, (SB 14-180), ch. 314, p. 1358, � 1, effective May 31.
Colo. Rev. Stat. § 25.5-3-402 Legislative declaration
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(1) The general assembly hereby finds and declares that: (a) The purpose of this part 4 is to promote the health and welfare of Colorado low-income seniors by providing access to patient-centered dental care and services to individuals sixty years of age or older whose income and…
Colo. Rev. Stat. § 25.5-3-403 Definitions
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As used in this part 4, unless the context otherwise requires: (1) Advisory committee means the senior dental advisory committee created in section 25.5-3-406. (2) Covered dental care services are to be defined by rules of the medical services board pursuant to section 25.5-3-404…
Colo. Rev. Stat. § 25.5-3-405 Program reporting
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(1) On or before September 1, 2015, and each September 1 thereafter, each qualified grantee receiving a dental health-care services grant shall report to the state department concerning the number of eligible seniors served, the types of dental and oral health services provided, …
Colo. Rev. Stat. § 25.5-3-406 Senior dental advisory committee - creation - duties - repeal
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(1) (a) There is created in the state department a senior dental advisory committee comprised of eleven members appointed by the executive director as follows: (I) A member representing the state department; (II) A dentist in private practice providing dental care to the senior p…
Colo. Rev. Stat. § 25.5-3-501 Definitions
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As used in this part 5, unless the context otherwise requires: (1) Health-care facility means: (a) A hospital licensed as a general hospital pursuant to part 1 of article 3 of title 25; (b) A hospital established pursuant to section 23-21-503 or 25-29-103; (c) [Editor's note: Thi…
Colo. Rev. Stat. § 25.5-3-504 Notification of patients' rights
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(1) Beginning September 1, 2022, a health-care facility shall make information developed by the state department about patients' rights under this part 5 and the uniform application developed by the state department pursuant to section 25.5-3-505 (2)(i) available to the public an…
Colo. Rev. Stat. § 25.5-3-506 Limitations on collection actions - private enforcement
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(1) Beginning September 1, 2022, before assigning or selling patient debt to a collection agency, as defined in section 5-16-103 (3)(a), or a debt buyer, as defined in section 5-16-103 (8.5), or before pursuing, either directly or indirectly, any permissible extraordinary collect…
Colo. Rev. Stat. § 25.5-3-507 Hospital discounted care advisory committee - repeal
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(1) The hospital discounted care advisory committee is created in the state department. The advisory committee consists of the following members, appointed by the executive director: (a) Three members who are health-care consumers, of whom no more than two members may be employed…
Colo. Rev. Stat. § 25.5-3-601 Legislative declaration
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(1) The general assembly finds and declares that: (a) Safety net providers in the state incur significant costs by providing services to a large portion of the state's low-income, uninsured populations and individuals and families enrolled in medicaid or the children's basic heal…
Colo. Rev. Stat. § 25.5-3-602 Definitions
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As used in this part 6, unless the context otherwise requires: (1) Children's basic health plan has the same meaning as set forth in section 25.5-8-103 (2). (2) Eligible safety net provider means a safety net provider determined, pursuant to section 25.5-3-604 (2), to be eligible…
Colo. Rev. Stat. § 25.5-3-603 Provider stabilization fund - creation - use
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(1) (a) The provider stabilization fund is created in the state treasury. The provider stabilization fund consists of: (I) Money credited to the fund as a loan from the unclaimed property trust fund pursuant to section 38-13-801 (6); (II) Any other money the general assembly may …
Colo. Rev. Stat. § 25.5-3-604 Provider stabilization payments - eligibility
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(1) (a) The state department, in collaboration with the provider stabilization fund advisory board, shall annually allocate money appropriated by the general assembly from the provider stabilization fund as provider stabilization payments to safety net providers in the state that…
Colo. Rev. Stat. § 25.5-3-606 Provider stabilization fund report
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(1) Beginning September 1, 2026, and by each September 1 thereafter, the state department, with assistance from the advisory board, shall prepare and submit an annual report concerning the provider stabilization fund to: (a) The health and human services committee of the house of…
Colo. Rev. Stat. § 25.5-4-101 Short title
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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
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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
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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
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(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
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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
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(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
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(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
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(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
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(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
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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
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(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
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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
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(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
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(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
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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
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(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
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(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
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(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
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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
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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
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(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
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(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
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(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
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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
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(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
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(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
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(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
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(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…