Title 25.5, Health Care Policy and Financing
0 chapters · 273 sections in this title.
Colo. Rev. Stat. § 25.5-1-101 Short title
0.2K chars
This title shall be known and may be cited as the State Health Care Policy and Financing Act. Source: L. 93: Entire title added, p. 1097, � 15, effective July 1, 1994. L. 2006: Entire part amended, p. 1781, � 1, effective July 1.
Colo. Rev. Stat. § 25.5-1-102 Legislative declaration
1.3K chars
(1) The general assembly declares that state and local policymakers and health and human services administrators recognize that the management of and the delivery system for health and human services have become complex, fragmented, and costly and that the health and human servic…
Colo. Rev. Stat. § 25.5-1-103 Definitions
8.1K chars
As used in this title 25.5, unless the context otherwise requires: (1) County board means the county or district board of human or social services; except that, in the city and county of Denver, county board means the department or agency with the responsibility for public assist…
Colo. Rev. Stat. § 25.5-1-105 Transfer of functions
3.7K chars
(1) The state department shall, on and after July 1, 1994, execute, administer, perform, and enforce the rights, powers, duties, functions, and obligations vested prior to July 1, 1994, in the Colorado health data commission within the department of local affairs, the department …
Colo. Rev. Stat. § 25.5-1-105.5 Chief medical officer - qualifications
4.6K chars
(1) The executive director shall appoint a chief medical officer who shall: (a) Have a degree of doctor of medicine or doctor of osteopathy and be licensed to practice medicine in the state of Colorado; (b) Have at least two years of postgraduate experience in primary care; and (…
Colo. Rev. Stat. § 25.5-1-108 Executive director - rules
1.1K chars
(1) The executive director shall have authority to promulgate rules in connection with the policies and procedures governing the administration of the department including, but not limited to, rules concerning the following: (a) Matters of internal administration of the departmen…
Colo. Rev. Stat. § 25.5-1-109 Department of health care policy and financing cash fund
0.6K chars
All moneys collected by the state department as fees or otherwise shall be transmitted to the state treasurer, who shall credit the same to the department of health care policy and financing cash fund, which fund is hereby created in the state treasury. Moneys in the fund shall b…
Colo. Rev. Stat. § 25.5-1-109.5 Clinical standards - development
1.8K chars
(1) The general assembly finds that: (a) It is important to collect and analyze objective clinical standards to maximize the scarce dollars available for medical care; and (b) The development of an ongoing, transparent measurement of health outcomes is essential to ensure quality…
Colo. Rev. Stat. § 25.5-1-1101 Legislative declaration
2.3K chars
(1) The general assembly finds and declares that: (a) The United States supreme court decision in Olmstead v. L.C., 527 U.S. 581 (1999), referred to in this part 11 as Olmstead, enshrined in law the duty upon states to actively work toward helping individuals with disabilities tr…
Colo. Rev. Stat. § 25.5-1-1102 Definitions
3.1K chars
As used in this part 11, unless the context otherwise requires: (1) Community-based services means any of the following: (a) Home health-care services authorized pursuant to paragraph (7) of section 1905(a) of the Social Security Act, 42 U.S.C. sec. 1396d(a); (b) Personal care se…
Colo. Rev. Stat. § 25.5-1-1103 Case management-based services and activities
1.4K chars
Each public and governmental entity shall administer services, programs, and activities in the most integrated setting appropriate to the needs of a qualified individual with a disability. Source: L. 2025: Entire part added, (HB 25-1017), ch. 231, p. 1094, � 2, effective August 6…
Colo. Rev. Stat. § 25.5-1-1105 Exception for fundamental alteration of an entity's program
2.1K chars
(1) A public or governmental entity is not required to comply with this part 11 if doing so would require a fundamental alteration of the entity's program. (2) (a) The following factors must be considered for purposes of evaluating a fundamental alteration defense to not complyin…
Colo. Rev. Stat. § 25.5-1-111 Waiver applications - authorization. (Deleted by amendment)
0.1K chars
Source: L. 2002: Entire section added, p. 1308, � 27, effective June 7. L. 2006: Entire part amended, p. 1787, � 1, effective July 1.
Colo. Rev. Stat. § 25.5-1-112 Drug-purchasing pool - report - repeal. (Repealed)
0.3K chars
Source: L. 2004: Entire section added, p. 1995, � 9, effective June 5. L. 2006: Entire part amended, p. 1787, � 1, effective July 1. Editor's note: Subsection (3) provided for the repeal of this section, effective July 1, 2005. (See L. 2004, p. 1995.)
Colo. Rev. Stat. § 25.5-1-113 Federal authorization - repeal. (Deleted by amendment)
0.1K chars
Source: L. 2005: Entire section added, p. 1230, � 9, effective June 3. L. 2006: Entire part amended, p. 1787, � 1, effective July 1.
Colo. Rev. Stat. § 25.5-1-113.5 Children's access to health care - reports. (Repealed)
0.2K chars
Source: L. 2007: Entire section added, p. 1494, � 8, effective July 1. L. 2017: Entire section repealed, (HB 17-1060), ch. 6, p. 14, � 1, effective March 1.
Colo. Rev. Stat. § 25.5-1-114 Grants-in-aid - county supervision
2.4K chars
(1) The state department shall consult with and coordinate with the counties before making any changes that affect county operations in the implementation of this section, when possible under state statutes and federal statutes and regulations. (2) In administering any funds appr…
Colo. Rev. Stat. § 25.5-1-115 Locating violators - recoveries
5.4K chars
(1) The executive director of the state department, or district attorneys may request and shall receive from departments, boards, bureaus, or other agencies of the state or any of its political subdivisions, and the same are authorized to provide, such assistance and data as will…
Colo. Rev. Stat. § 25.5-1-115.5 Medical assistance fraud - report
9.5K chars
(1) Notwithstanding section 24-1-136 (11)(a)(I), on or before November 1, 2017, and each November 1 thereafter, the state department shall submit a written report to the joint budget committee; to the house of representatives judiciary committee and the house of representatives p…
Colo. Rev. Stat. § 25.5-1-117 County departments - district departments
1.6K chars
(1) Except as provided in subsection (2) of this section, there is established in each county of the state a county department of human or social services that consists of a county board of human or social services, a county director of human or social services, and any additiona…
Colo. Rev. Stat. § 25.5-1-118 Duties of county departments
1.0K chars
(1) The county departments or other state designated agencies, where applicable, shall serve as agents of the state department and shall be charged with the administration of medical assistance and related activities in the respective counties in accordance with the rules of the …
Colo. Rev. Stat. § 25.5-1-119 County staff
1.0K chars
The county director, with the approval of the county board, shall appoint such staff as may be necessary as determined by the state department rules to administer medical assistance within the county. The staff shall be appointed and shall serve in accordance with a merit system …
Colo. Rev. Stat. § 25.5-1-120 Appropriations
2.8K chars
(1) (a) For carrying out the duties and obligations of the state department and county departments under the provisions of this title and for matching such federal funds or meeting maintenance of effort requirements as may be available for public assistance and welfare activities…
Colo. Rev. Stat. § 25.5-1-121 County expenditures - advancements - procedures
3.1K chars
(1) For purposes of this article, under rules of the state department, administrative costs shall include: Salaries of the county director and employees of the county department staff engaged in the performance of medical assistance activities; the county's payments on behalf of …
Colo. Rev. Stat. § 25.5-1-122 County appropriation increases - limitations
9.7K chars
(1) Beginning in calendar fiscal year 1994 and for each calendar fiscal year thereafter to and including calendar fiscal year 1997, the board of county commissioners in each county of this state shall annually appropriate funds for the county share of the administrative costs of …
Colo. Rev. Stat. § 25.5-1-126 Discounted prices for durable medical equipment and supplies
0.9K chars
(1) The state department shall work with one or more nonprofit organizations to develop a link of approved vendors who are willing to sell durable medical equipment and medical supplies at discounted prices to persons who have applied for, but are not yet receiving, benefits unde…
Colo. Rev. Stat. § 25.5-1-127 Third-party benefit denials information
14.0K chars
The state department shall provide information to members who receive benefits under this title 25.5 concerning the members' right to appeal a denial of benefits by a third party and shall post information on the state department's website concerning members' abilities to appeal …
Colo. Rev. Stat. § 25.5-1-131 Insurance ombudsman - consumer advocate - duties
14.0K chars
(1) There is hereby created in the state department the office of the insurance ombudsman to act as the advocate for consumer interests in matters related to access to and the affordability of the standardized health benefit plan created pursuant to section 10-16-1304. The ombuds…
Colo. Rev. Stat. § 25.5-1-136 Billing manual
0.4K chars
Using existing resources allocated for billing manual reviews, the state department shall establish a process to review and update the general billing manual on an annual basis, which must ensure that the general billing manual includes all necessary CPT codes, or provides links …
Colo. Rev. Stat. § 25.5-1-301 Medical services board - creation
2.7K chars
(1) (a) There is created in the state department the medical services board, referred to in this part 3 as the board. The board consists of members appointed by the governor with the consent of the senate as follows: (I) One member from each congressional district in the state; a…
Colo. Rev. Stat. § 25.5-1-302 Medical services board - organization
1.2K chars
(1) The board shall elect from its members a president, a vice-president, and such other board officers as it shall determine. All board officers shall hold their offices at the pleasure of the board. (2) Regular meetings of the board shall be held not less than once every three …
Colo. Rev. Stat. § 25.5-1-303 Powers and duties of the board - scope of authority - rules
4.7K chars
(1) The board shall have the authority set forth in subsection (3) of this section over the following programs administered by the state department: (a) The Colorado Medical Assistance Act, as specified in articles 4, 5, and 6 of this title; (b) and (c) Repealed. (d) The Children…
Colo. Rev. Stat. § 25.5-1-304 Repeal of part. (Deleted by amendment)
0.2K chars
Source: L. 94: Entire part added, p. 1559, � 2, effective July 1. L. 2000: Entire section amended, p. 410, � 9, effective April 13. L. 2006: Entire part amended, p. 1800, � 3, effective July 1.
Colo. Rev. Stat. § 25.5-1-401 (Repealed)
0.4K chars
Source: L. 2004: Entire part repealed, p. 1011, � 23, effective August 4. Editor's note: This part 4 was added in 1994. For amendments to this part 4 prior to its repeal in 2004, consult the Colorado statutory research explanatory note and the table itemizing the replacement volu…
Colo. Rev. Stat. § 25.5-1-601 Legislative declaration
0.9K chars
(1) The general assembly hereby finds and declares that: (a) Physicians engaged in family medicine are in critically short supply in this state; (b) Because of the distribution of such physicians, many rural and urban areas of the state are underserved; (c) A significant portion …
Colo. Rev. Stat. § 25.5-1-601.5 Definitions
0.3K chars
As used in this part 6, unless the context otherwise requires: (1) Commission means the commission on family medicine created in section 25.5-1-602 (1). Source: L. 2025: Entire section added, (SB 25-275), ch. 377, p. 2081, � 223, effective August 6.
Colo. Rev. Stat. § 25.5-1-602 Commission created - composition - terms of office
2.4K chars
(1) There is created, in the department of health care policy and financing, the commission on family medicine. The commission consists of the following members: (a) The deans of accredited allopathic and osteopathic schools of medicine in the state or their designated representa…
Colo. Rev. Stat. § 25.5-1-603 Duties of commission - reporting
2.0K chars
(1) The commission shall: (a) Assure that family medicine residency program standards are equal to or more stringent than the standards established by the accreditation council on graduate medical education of the American medical association or the American osteopathic associati…
Colo. Rev. Stat. § 25.5-1-701 Definitions
1.5K chars
As used in this part 7, unless the context otherwise requires: (1) Community means the community that a hospital has defined as the community that it serves pursuant to 26 CFR 1.501(r)-3 (b)(3). (2) Community benefit implementation plan means a plan that satisfies the requirement…
Colo. Rev. Stat. § 25.5-1-702 Hospitals - public community meeting requirement - rules
13.9K chars
(1) At least once each year, each reporting hospital shall convene a public meeting to seek feedback regarding the reporting hospital's community benefit activities during the previous year and the reporting hospital's community benefit implementation plan for the following year.…
Colo. Rev. Stat. § 25.5-1-704 Hospital community investment compliance - rules
1.9K chars
(1) (a) If the state department finds that a reporting hospital is not in compliance with the community benefit requirements of this part 7, the state department shall notify the reporting hospital of its noncompliance and identify the information that needs to be provided. If a …
Colo. Rev. Stat. § 25.5-1-801 Definitions
1.1K chars
As used in this section, unless the context otherwise requires: (1) Nonemergency medical transportation means transportation to or from medically necessary nonemergency treatment. (2) Nonmedical transportation means transportation to enable passengers who are medicaid members to …
Colo. Rev. Stat. § 25.5-1-802 Medicaid transportation services - safety and oversight - rules
1.6K chars
(1) The state department shall collaborate with stakeholders, including, but not limited to, disability and consumer advocates, PACE providers operating pursuant to section 25.5-5-412, transportation brokers, and transportation providers, to establish rules and processes for the …
Colo. Rev. Stat. § 25.5-1-901 Legislative declaration
3.0K chars
(1) The general assembly finds and declares that: (a) Section 1001 of the Patient Protection and Affordable Care Act, Pub.L. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Pub.L. 111-152, amended Title XXVII of the Public Health Service Act, Pub.…
Colo. Rev. Stat. § 25.5-1-902 Definitions
10.3K chars
As used in this part 9, unless the context otherwise requires: (1) Collection action means any of the following actions taken with respect to a debt for items and services that were purchased from or provided to a patient by a hospital on a date during which the hospital was not …
Colo. Rev. Stat. § 25.5-2-103 Reproductive health-care program - report - rules - definitions
4.5K chars
(1) As used in this section, unless the context otherwise requires: (a) Repealed. (b) Eligible individual means an individual with reproductive capacity, regardless of gender, who would be eligible to enroll in the medical assistance program, as described in section 25.5-4-103 (1…
Colo. Rev. Stat. § 25.5-2-104 State-funded health and medical care
3.4K chars
(1) Beginning no later than January 1, 2025, there is created the state medical assistance program, referred to in this section as state medical assistance. State medical assistance includes all benefits and services at the same cost to the beneficiary as are offered pursuant to …
Colo. Rev. Stat. § 25.5-2-105 State children's basic health plan
3.4K chars
(1) Beginning no later than January 1, 2025, there is created the state children's basic health plan. The state children's basic health plan includes all benefits and services, at the same cost to the beneficiary, as are offered pursuant to the children's basic health plan in sec…
Colo. Rev. Stat. § 25.5-2-106 State-funded abortion care
0.3K chars
[Editor's note: This section is effective January 1, 2026.] When abortion care services are provided in accordance with articles 4, 5, and 6 of this title 25.5, the services must be reimbursed by state funds only. Source: L. 2025: Entire section added, (SB 25-183), ch. 97, p. 443…
Colo. Rev. Stat. § 25.5-2-107 State-only funding for certain entities - application - rules
0.7K chars
(1) The state department shall reimburse a prohibited entity, as defined in Pub.L. 119-21 sec. 71113, using only state funds for services covered under Title XIX of the federal Social Security Act and provided on or after July 1, 2025, except those services covered pursuant to se…