§ 25.5-5-103 — Mandated programs with special state provisions - rules

Colorado § 25.5-5-103

• Jurisdiction: Colorado
• Title 25.5: Health
• Art.: Colorado Medical Assistance Act -

Text

(1)
This section specifies programs developed by Colorado to meet federal mandates.
These programs include but are not limited to:

(a) Repealed.

(b) Special provisions relating to nursing facilities, as specified in sections
25.5-4-402.4 (4.5) and (5.5), 25.5-6-201, 25.5-6-202, 25.5-6-205, and 25.5-6-206;

(c) The program for qualified medicare beneficiaries, as specified in section
25.5-5-104;

(d) The program for qualified disabled and working individuals, as specified
in section 25.5-5-105;

(e) Special provisions for the purchase of group health insurance for
members, as specified in section 25.5-4-210;

(f) The program to provide health services to students by school districts as
specified in section 25.5-5-318.

(2) [ Editor's note: This version of subsection (2) is effective until January 1,
2026. ] The medical assistance program also is subject to special provisions relating
to the use of public funds for abortion which are required by section 50 of article V
of the Colorado constitution. Those special provisions are specified in section 25.5-4-415.

(2) [ Editor's note: This version of subsection (2) is effective January 1, 2026. ] Repealed.

(3) (a) Emergency medical assistance shall be provided to any person who is
not a citizen of the United States, including undocumented aliens, aliens who are
not qualified aliens, and qualified aliens who entered the United States on or after
August 22, 1996, who has an emergency medical condition and meets one of the
categorical requirements set forth in section 25.5-5-101; except that such persons
shall not be required to meet any residency requirement other than that required by
federal law.

(b) The state board shall adopt rules necessary for the implementation of
this subsection (3), including in such rules definitions of emergency services,
emergency medical condition, geographic area, and prenatal care.

(4) (a) The state department shall ensure that benefits under the medical
assistance program for behavioral, mental health, and substance use disorder
services are no less extensive than benefits for any physical illness and are in
compliance with the MHPAEA, as defined in section 25.5-5-403 (5.7), including the
quantitative and nonquantitative treatment limitation requirements specified in 42
CFR 438.910 (c) and (d). On or after January 1, 2020, if an MCE, as defined in section
25.5-5-403 (4), denies coverage for a covered behavioral, mental health, or
substance use disorder benefit or service based on diagnosis, the state board shall
establish, by rule, a procedure to allow for reimbursement of medically necessary
state plan services under the medical assistance program. The state department
may use multiple payment modalities to comply with this subsection (4).

(b) The state board shall adopt rules establishing the procedures for
reimbursement pursuant to this subsection (4) by January 1, 2020.

Legislative History

Source: L. 2006: Entire article added with relocations, p. 1856, � 7, effective July 1. L. 2014: (1)(a) repealed, (SB 14-067), ch. 12, p. 113, � 4, effective February 27. L. 2019: (4) added, (HB 19-1269), ch. 195, p. 2132, � 11, effective May 16. L. 2021: (4)(a) amended, (SB 21-266), ch. 423, p. 2802, � 22, effective July 2. L. 2024: (1)(e) amended, (SB 24-176), ch. 152, p. 645, � 43, effective August 7. L. 2025: (1)(b) amended, (SB 25-270), ch. 151, p. 598, � 3, effective May 1; (2) repealed, (SB 25-183), ch. 97, p. 444, � 7, effective January 1, 2026.