C.R.S. Section 25.5-5-325
Residential and inpatient substance use disorder treatment

  • medical detoxification services
  • federal approval
  • performance review report

(1)

Subject to available appropriations and to the extent permitted under federal law, the medical assistance program pursuant to this article 5 and articles 4 and 6 of this title 25.5 includes residential and inpatient substance use disorder treatment and medical detoxification services. Participation in the residential and inpatient substance use disorder treatment and medical detoxification services benefit is limited to persons who meet nationally recognized, evidence-based level of care criteria for residential and inpatient substance use disorder treatment and medical detoxification services. The benefit shall serve persons with substance use disorders, including those with co-occurring mental health disorders. All levels of nationally recognized, evidence-based levels of care for residential and inpatient substance use disorder treatment and medical detoxification services must be included in the benefit.

(2)

Intentionally left blank —Ed.

(a)

No later than October 1, 2018, the state department shall seek federal authorization to provide residential and inpatient substance use disorder treatment and medical detoxification services with full federal financial participation. Residential and inpatient substance use disorder treatment and medical detoxification services shall not take effect until federal approval has been obtained.

(b)

Prior to seeking federal approval pursuant to subsection (2)(a) of this section, the state department shall seek input from relevant stakeholders, including existing providers of substance use disorder treatment and medical detoxification services and behavioral health administrative services organizations. The state department shall seek input and involve stakeholders in decisions regarding:

(I)

The coordination of benefits with behavioral health administrative services organizations and the department of human services;

(II)

The most appropriate entity for administration of the benefit;

(III)

The provision of wraparound services needed during treatment and the provision of required services following treatment that may not be covered through the medical assistance program;

(IV)

The authorization process for approval of services; and

(V)

The development of a reimbursement rate methodology to ensure sustainability that considers a provider’s cost of providing care, including lower-volume providers in rural areas.

(3)

Intentionally left blank —Ed.

(a)

No later than January 15, 2022, the state department shall prepare and submit a performance review report to the joint budget committee and to the joint health and human services committee, or any successor committees, concerning the residential and inpatient substance use disorder treatment pursuant to this section, including, at a minimum:

(I)

The number of persons who received services pursuant to this section and the service provided;

(II)

The length of time that services were provided;

(III)

The location where services were provided;

(IV)

The effectiveness of the services provided, including the rate of relapse to substance use disorder following treatment; and

(V)

Any other information as determined by the state department that is relevant to the benefit.

(b)

After considering the state department’s performance review report, the general assembly may enact legislation modifying or repealing the benefit.

Source: Section 25.5-5-325 — Residential and inpatient substance use disorder treatment - medical detoxification services - federal approval - performance review report, https://leg.­colorado.­gov/sites/default/files/images/olls/crs2023-title-25.­5.­pdf (accessed Oct. 20, 2023).

25.5‑5‑101
Mandatory provisions - eligible groups - rules - repeal
25.5‑5‑102
Basic services for the categorically needy - mandated services
25.5‑5‑103
Mandated programs with special state provisions - rules
25.5‑5‑104
Qualified medicare beneficiaries
25.5‑5‑105
Qualified disabled and working individuals
25.5‑5‑201
Optional provisions - optional groups - rules - repeal
25.5‑5‑202
Basic services for the categorically needy - optional services
25.5‑5‑203
Optional programs with special state provisions - repeal
25.5‑5‑204
Presumptive eligibility - pregnant person - children - long-term care - state plan
25.5‑5‑204.5
Continuous eligibility - children
25.5‑5‑206
Medicaid buy-in program - disabled children - disabled adults - federal authorization - rules
25.5‑5‑207
Adult dental benefit - adult dental fund - creation - legislative declaration
25.5‑5‑208
Additional services - training - grants - screening, brief intervention, and referral
25.5‑5‑301
Clinic services
25.5‑5‑302
Clinic services - children and pregnant women - utilization of certain providers
25.5‑5‑303
Private-duty nursing
25.5‑5‑304
Hospice care
25.5‑5‑305
Pediatric hospice care - legislative declaration - federal authorization - rules - fund
25.5‑5‑307
Child mental health treatment and family support program
25.5‑5‑308
Breast and cervical cancer prevention and treatment program - creation - legislative declaration - definitions - funds - repeal
25.5‑5‑309
Pregnant women - needs assessment - referral to treatment program - definition
25.5‑5‑310
Treatment program for high-risk pregnant and parenting women - cooperation with private entities - definition
25.5‑5‑311
Treatment program for high-risk pregnant and parenting women - data collection
25.5‑5‑312
Treatment program for high-risk pregnant and parenting women - extended coverage - federal approval
25.5‑5‑314
Substance use disorder treatment for Native Americans - federal approval
25.5‑5‑315
Acceptance of gifts, grants, and donations - Native American substance abuse treatment cash fund
25.5‑5‑316
Legislative declaration - state department - disease management programs authorization - report
25.5‑5‑318
Health services - provision by school districts - repeal
25.5‑5‑319
Family planning pilot program - rules - federal waiver - repeal
25.5‑5‑320
Telemedicine - reimbursement - disclosure statement - rules - definition
25.5‑5‑321
Telemedicine - home health care - home health telemedicine cash fund - rules - repeal
25.5‑5‑321.5
Telehealth - interim therapeutic restorations - reimbursement - definitions
25.5‑5‑322
Over-the-counter medications - rules
25.5‑5‑323
Complex rehabilitation technology - no prior authorization - metrics - report - rules - legislative declaration - definitions
25.5‑5‑324
Nonemergency medical transportation - urgent and secure transportation need - report - repeal
25.5‑5‑325
Residential and inpatient substance use disorder treatment - medical detoxification services - federal approval - performance review report
25.5‑5‑326
Access to clinical trials - definitions
25.5‑5‑327
Eligible peer support services - reimbursement - definitions
25.5‑5‑328
Secure transportation for behavioral health crises - benefit - funding
25.5‑5‑329
Family planning services - federal authorization - rules - definitions
25.5‑5‑330
Screening for perinatal mood and anxiety disorder
25.5‑5‑331
Federally qualified health center - clinical pharmacy services - reimbursement - rules
25.5‑5‑332
Therapy using equine movement - federal authorization - definition
25.5‑5‑333
Primary care and behavioral health statewide integration grant program - creation - report - definition - repeal
25.5‑5‑334
Community health worker services - federal authorization - reporting - rules - definition
25.5‑5‑335
Continuous medical coverage for children and adults feasibility study - federal authorization - rules - report - definition
25.5‑5‑336
Prohibition on using the body mass index or ideal body weight - medical necessity criteria
25.5‑5‑401
Short title
25.5‑5‑402
Statewide managed care system - rules - definitions - repeal
25.5‑5‑403
Definitions
25.5‑5‑406.1
Required features of statewide managed care system
25.5‑5‑408
Capitation payments - availability of base data - adjustments - rate calculation - capitation payment proposal - preference - assignment of medicaid recipients - definition
25.5‑5‑410
Data collection for managed care programs
25.5‑5‑412
Program of all-inclusive care for the elderly - services - eligibility - legislative declaration - rules - definitions
25.5‑5‑414
Telemedicine - legislative intent
25.5‑5‑415
Medicaid payment reform and innovation pilot program - legislative declaration - creation - selection of payment projects - report - rules
25.5‑5‑418
Primary care provider sustainability fund - creation - use of fund
25.5‑5‑419
Accountable care collaborative - reporting - rules
25.5‑5‑420
Advancing care for exceptional kids
25.5‑5‑421
Parity reporting - state department - public input
25.5‑5‑422
Medication-assisted treatment - limitations on MCEs - definition
25.5‑5‑423
Independent review organization - review denial of residential and inpatient substance use disorder treatment claims - contract
25.5‑5‑424
Residential and inpatient substance use disorder treatment - MCE standardized utilization management process - medical necessity - report
25.5‑5‑425
Audit of MCE denials for residential and inpatient substance use disorder treatment authorization - report
25.5‑5‑500.3
Authorization to bill third party
25.5‑5‑501
Providers - drug reimbursement
25.5‑5‑502
Unused medications - reuse - rules - definition
25.5‑5‑503
Prescription drug benefits - authorization - dual-eligible participation
25.5‑5‑504
Providers of pharmaceutical services
25.5‑5‑505
Prescribed drugs - mail order - rules
25.5‑5‑506
Prescribed drugs - utilization review
25.5‑5‑507
Prescription drug information and technical assistance program - rules
25.5‑5‑509
Substance use disorder - prescription drugs - opiate antagonist
25.5‑5‑510
Pharmacy reimbursement - substance use disorder - injections
25.5‑5‑511
Reimbursement for pharmacists’ services - legislative declaration
25.5‑5‑512
Pharmacy benefit - mental health and substance use disorders - legislative declaration
25.5‑5‑513
Pharmacy benefits - prescription drugs - rebates - analysis
25.5‑5‑514
Prescription drugs used for treatment or prevention of HIV - prohibition on utilization management - definition
25.5‑5‑515
Pharmacy reimbursement - vaccine administration to children - legislative declaration
25.5‑5‑516
Serious mental illness - prescribed drugs
25.5‑5‑801
Legislative declaration
25.5‑5‑802
Definitions
25.5‑5‑803
High-fidelity wraparound services for children and youth - federal approval - reporting
25.5‑5‑804
Integrated funding pilot
Green check means up to date. Up to date

Current through Fall 2024

§ 25.5-5-325’s source at colorado​.gov