C.R.S. Section 25.5-4-406
Rate setting

  • medicaid residential treatment service providers
  • monitoring and auditing
  • report

(1)

The state department shall approve a rate-setting process consistent with medicaid requirements for providers of medicaid residential treatment services in the state of Colorado as developed by the department of human services. The rate-setting process developed pursuant to this section may include, but shall not be limited to:

(a)

A range for reimbursement that represents a base-treatment rate for serving a child who is subject to out-of-home placement due to dependency and neglect, a child placed in a residential child care facility pursuant to the “Children and Youth Mental Health Treatment Act”, article 67 of title 27, or a child who has been adjudicated a delinquent, which includes a defined service package to meet the needs of the child;

(b)

A request for proposal to contract for specialized service needs of a child, including but not limited to: Substance-abuse treatment services; sex offender services; and services for the developmentally disabled; and

(c)

Negotiated incentives for achieving outcomes for the child as defined by the state department, counties, and providers.

(2)

The medicaid rate-setting process approved by the state department shall include a two- or three-year implementation timeline with implementation beginning in state fiscal year 2008-09.

(3)

The state department and the department of human services, in consultation with the representatives of the counties and the provider community, shall review the rate-setting process every two years and shall submit any changes to the joint budget committee of the general assembly.

Source: Section 25.5-4-406 — Rate setting - medicaid residential treatment service providers - monitoring and auditing - report, https://leg.­colorado.­gov/sites/default/files/images/olls/crs2023-title-25.­5.­pdf (accessed Oct. 20, 2023).

25.5‑4‑101
Short title 25.5‑4‑102
Legislative declaration 25.5‑4‑103
Definitions 25.5‑4‑104
Program of medical assistance - single state agency 25.5‑4‑105
Federal requirements under Title XIX 25.5‑4‑106
Cooperation with federal government - grants-in-aid - cooperation with the state department of human services in delivery of services 25.5‑4‑107
Retaliation definition 25.5‑4‑201
Cash system of accounting - financial administration of medical services premiums - medical programs administered by department of human services - federal contributions - rules 25.5‑4‑203
Advisory council established 25.5‑4‑204
Automated medical assistance administration 25.5‑4‑205
Application - verification of eligibility - demonstration project - rules - repeal 25.5‑4‑205.5
Confined persons - suspension of benefits 25.5‑4‑206
Reimbursement to counties - costs of administration 25.5‑4‑207
Appeals - rules - applicability 25.5‑4‑208
County duties - transitional medicaid 25.5‑4‑209
Payments by third parties - copayments by recipients - review - appeal - children’s waiting list reduction fund - rules - repeal 25.5‑4‑210
Purchase of health insurance for recipients 25.5‑4‑211
Medicaid management information system - appropriation in annual general appropriation act - expenditure in next fiscal year 25.5‑4‑212
Medicaid client correspondence improvement process - legislative declaration - definition 25.5‑4‑213
Audit of medicaid client correspondence - definition 25.5‑4‑215
Study - benefits for persons on work release - repeal 25.5‑4‑216
Report on impact of hospital facility fees in Colorado - definitions - steering committee - repeal 25.5‑4‑300.4
Last resort for payment - legislative intent 25.5‑4‑300.7
Prevention of coding errors - prepayment review of claims 25.5‑4‑300.9
Explanation of benefits - medicaid recipients - legislative declaration 25.5‑4‑301
Recoveries - overpayments - penalties - interest - adjustments - liens - review or audit procedures - repeal 25.5‑4‑302
Recovery of assets 25.5‑4‑303
State income tax refund intercept - garnishment of earning - failure to provide medical support for child 25.5‑4‑303.3
Provider fraud - attorney general report 25.5‑4‑303.5
Short title 25.5‑4‑304
Definitions 25.5‑4‑305
False medicaid claims - liability for certain acts 25.5‑4‑306
Civil actions for false medicaid claims 25.5‑4‑307
False medicaid claims procedures - statute of limitations 25.5‑4‑308
False medicaid claims jurisdiction 25.5‑4‑309
False medicaid claims civil investigation demands 25.5‑4‑310
Medicaid false claims report 25.5‑4‑401
Providers - payments - rules 25.5‑4‑401.2
Performance-based payments - reporting - repeal 25.5‑4‑401.5
Review of provider rates - advisory committee - recommendations - repeal 25.5‑4‑402
Providers - hospital reimbursement - hospital review program - rules 25.5‑4‑402.4
Hospitals - healthcare affordability and sustainability fee - legislative declaration - Colorado healthcare affordability and sustainability enterprise - federal waiver - fund created - rules - reports - repeal 25.5‑4‑402.5
Providers - state university teaching hospitals 25.5‑4‑402.8
Hospital transparency report - definitions 25.5‑4‑403
Providers - behavioral health safety net providers - reimbursement 25.5‑4‑403.1
Providers - community mental health centers - cost reporting 25.5‑4‑404
Payments for clinic services - restrictions on use 25.5‑4‑405
Mental health managed care service providers - requirements 25.5‑4‑406
Rate setting - medicaid residential treatment service providers - monitoring and auditing - report 25.5‑4‑407
Services by licensed psychologists without a doctor’s referral 25.5‑4‑408
Services provided by licensed psychologists - cost containment program 25.5‑4‑409
Authorization of services - nurse anesthetists - advanced practice registered nurses 25.5‑4‑410
Services of audiologists and speech pathologists without supervision 25.5‑4‑411
Authorization of services provided by dental hygienists 25.5‑4‑412
Family planning services - family-planning-related services - rules - definitions 25.5‑4‑413
Certain providers to inform patients of rights concerning advance medical directives 25.5‑4‑414
Providers - physicians - prohibition of certain referrals - definitions 25.5‑4‑415
No public funds for abortion - exception - definitions - repeal 25.5‑4‑416
Providers - medical equipment and supplies - requirements 25.5‑4‑417
Provider fee - medicaid providers - state plan amendment - rules - definitions 25.5‑4‑420
Providers to obtain unique NPI - service site - provider type - definitions 25.5‑4‑422
Cost control - legislative intent - use of technology - stakeholder feedback - reporting - rules 25.5‑4‑423
Targets for investments in primary care 25.5‑4‑425
Providers - health-care services related to labor and delivery - reimbursement 25.5‑4‑427
Supplemental state payment to the Denver health and hospital authority - repeal 25.5‑4‑428
Prior authorization for a step-therapy exception - rules - definition 25.5‑4‑429
Hospital and provider billing requirements - description of service provided - rules 25.5‑4‑430
Increasing access to behavioral health care for children and youth - directed payment authority - fee schedule rates 25.5‑4‑503
Waiver applications - authorization 25.5‑4‑505
Federal authorization related to persons involved in the criminal justice system - assessment - report - repeal 25.5‑4‑506
Coverage for doula services - stakeholder process - federal authorization - scholarship program - training - report - definitions - repeal
Green check means up to date. Up to date

Current through Fall 2024

§ 25.5-4-406’s source at colorado​.gov