C.R.S. Section 25.5-5-424
Residential and inpatient substance use disorder treatment

MCE standardized utilization management process
medical necessity
report

(1)

On or before October 1, 2021, the state department shall consult with the behavioral health administration in the department of human services, residential treatment providers, and MCEs to develop standardized utilization management processes to determine medical necessity for residential and inpatient substance use disorder treatment. The processes must incorporate the most recent edition of “The ASAM Criteria for Addictive, Substance-related, and Co-occurring Conditions” and align with federal medicaid payment requirements.

(2)

On or before January 1, 2022, the state department shall incorporate the standards developed pursuant to subsection (1) of this section into existing MCE contracts, and each MCE shall adhere to the standards when conducting utilization management for residential and inpatient substance use disorder treatment.

(3)

On or before January 1, 2022, each MCE’s notice of an adverse benefit determination must demonstrate how each dimension of the most recent edition of “The ASAM Criteria for Addictive, Substance-related, and Co-occurring Conditions” was considered when determining medical necessity.

(4)

Intentionally left blank —Ed.

(a)

Beginning October 1, 2021, and quarterly thereafter, the state department shall collaborate with the behavioral health administration in the department of human services, residential treatment providers, and MCEs to develop a report on the residential and inpatient substance use disorder utilization management statistics. At a minimum, the report must include:

(I)

The average length of an initial authorization and the average length of continued authorizations for each MCE and provider disaggregated by level of residential care;

(II)

Denials of initial authorizations reported for each MCE and provider and the reasons for the denials; and

(III)

The average response time for an initial authorization and continued authorization, disaggregated by each MCE; level of residential care, including the percentage of extensions granted to health-care providers to submit complete clinical documentation; retroactive authorization requests; incomplete authorization requests; and the number of requests that met and did not meet the state department’s response time requirements.

(b)

The state department shall make the report developed pursuant to subsection (4)(a) of this section publicly available on the state department’s website.

(c)

Any information required to be reported pursuant to subsection (4)(a) of this section may be aggregated as necessary to ensure confidentially pursuant to 42 CFR part 2.

Source: Section 25.5-5-424 — Residential and inpatient substance use disorder treatment - MCE standardized utilization management process - medical necessity - report, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-25.5.pdf (accessed Oct. 20, 2023).

California:	Codes
Colorado:	C.R.S.
Nevada:	NRS
New York:	Laws
Oregon:	OAR, ORS
Texas:	Statutes
World:	Rome Statute, International Dictionary

C.R.S. Section 25.5-5-424 Residential and inpatient substance use disorder treatment

(1)

(2)

(3)

(4)

(a)

(I)

(II)

(III)

(b)

(c)

C.R.S. Section 25.5-5-424
Residential and inpatient substance use disorder treatment