C.R.S. Section 25.5-4-416
Providers

  • medical equipment and supplies
  • requirements

(1)

As used in this section, unless the context otherwise requires, “provider” means a person or entity that delivers disposable medical supplies or durable medical equipment products or services directly to a recipient.

(2)

On and after January 1, 2007, the state board rules for the payment for disposable medical supplies and durable medical equipment, including but not limited to prosthetic and orthotic devices, shall prohibit a provider from being reimbursed unless the provider:

(a)

Intentionally left blank —Ed.

(I)

Has one or more physical locations within the state of Colorado or within fifty miles of a border of Colorado with a street address, a local business telephone number, an inventory, and a sufficient staff to service or repair products; except that the requirements of this paragraph (a) shall not apply to durable medical equipment or disposable medical supplies that are medically necessary and cannot be purchased from a provider meeting the requirements of this paragraph (a);

(II)

Complies with all state and local licensing, insurance, and regulatory requirements for operating the provider’s business;

(III)

Is responsible for the delivery of and instructing the recipient on the proper use of the equipment; and

(IV)

Provides repairs, replacements, or adjustments to the provider’s products pursuant to rules of the state board; or

(b)

Contracts with a provider who meets the criteria established in paragraph (a) of this subsection (2).

(3)

The provisions of this section shall apply to fee-for-service and primary care physician program recipients.

Source: Section 25.5-4-416 — Providers - medical equipment and supplies - requirements, 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

§ 25.5-4-416’s source at colorado​.gov