C.R.S. Section 25.5-5-336
Prohibition on using the body mass index or ideal body weight

  • medical necessity criteria

(1)

Intentionally left blank —Ed.

(a)

Beginning July 1, 2023, the state medical assistance program shall not utilize the body mass index, ideal body weight, or any other standard requiring an achieved weight when determining medical necessity or the appropriate level of care for an individual diagnosed with an eating disorder, including but not limited to, bulimia nervosa, atypical anorexia nervosa, binge-eating disorder, avoidant restrictive food intake disorder, and other specified feeding and eating disorders as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.

(b)

Subsection (1)(a) of this section does not apply when determining medical necessity or the appropriate level of care for an individual diagnosed with anorexia nervosa, restricting subtype; however, body mass index, ideal body weight, or any other standard requiring an achieved body weight must not be the determining factor when assessing medical necessity or the appropriate level of care for an individual diagnosed with anorexia nervosa, restricting subtype.

(2)

The following factors, at a minimum, must be considered when determining medical necessity or the appropriate level of care for an individual diagnosed with an eating disorder:

(a)

The individual’s eating behaviors;

(b)

The individual’s need for supervised meals and support interventions;

(c)

Laboratory results, including but not limited to, the individual’s heart rate, renal or cardiovascular activity, and blood pressure;

(d)

The recovery environment; and

(e)

Co-occurring disorders the individual may have.

Source: Section 25.5-5-336 — Prohibition on using the body mass index or ideal body weight - medical necessity criteria, 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

§ 25.5-5-336’s source at colorado​.gov