Colorado § 25.5-1-128 - Provider payments - compliance with state fiscal requirements - rules - definitions.

§ 25.5-1-128. Provider payments - compliance with state fiscal requirements - rules - definitions.

(1) (a) Notwithstanding any provision of law to the contrary, when the state department has regulatory authority over a program and when the provider has already signed a state department-approved provider application to provide a service or to bill the state department or its authorized contractor for a service, the state department-approved provider application shall serve to fulfill the requirements of a commitment voucher and the fiscal requirements of section 24-30-202 (1), C.R.S.

(b) The executive director may promulgate rules to exempt a provider who provides services through a program as described in subsection (1)(a) of this section for any program the state department is authorized by law to administer, including but not limited to:

(I) The "Colorado Medical Assistance Act", articles 4 to 6 of this title;

(II) The "Children's Basic Health Plan Act", article 8 of this title;

(III) Repealed.

(IV) The school health services program authorized by section 25.5-5-318;

(V) Programs that are funded through the primary care fund, created in section 24-22-117 (2)(b), C.R.S.; and

(VI) The state-funded old age pension health and medical care program pursuant to article 2 of this title.

(1.5) The state department shall maintain a list of enrolled school-based health centers and school-linked health-care services providers. The state department shall develop the list based on grant enrollment data pursuant to section 25-20.5-503 that is provided to the state department by the department of public health and environment. The state department shall establish a process for identifying claims for services provided in these settings.

(2) As used in this section, unless the context otherwise requires, "provider" means a health-care provider; a mental health-care provider; a pharmacist; a home health agency; a general hospital, birth center, or community clinic licensed or certified by the department of public health and environment pursuant to section 25-1.5-103 (1)(a)(I) or (1)(a)(II); a federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec 1395x (aa)(4); a rural health clinic, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2); a health maintenance organization issued a certificate of authority pursuant to section 10-16-402; a school district as defined in section 25.5-5-318 (1)(a); or any other entity that provides health care, health-care coordination, outreach, enrollment, or administrative support services to members through fee-for-service, a managed care entity, a behavioral health organization, a medical home, or any system of care that coordinates health care or services as defined and authorized through rules promulgated by the state board or by the executive director.

Source: L. 2012: Entire section added, (HB 12-1054), ch. 14, p. 36, § 1, effective March 15. L. 2024: (1.5) added, (SB 24-034), ch. 404, p. 2775, § 4, effective August 7; (2) amended, (SB 24-176), ch. 152, p. 618, § 8, effective August 7; IP(1)(b) and (2) amended, (HB 24-1399), ch. 76, p. 256, § 21, effective July 1, 2025; and (1)(b)(III)(B) added by revision, (HB 24-1399), ch. 76, pp. 256, 260, §§ 21, 33.

Editor's note: (1) Amendments to subsection (2) by HB 24-1399 and SB 24-176 were harmonized, effective July 1, 2025.

(2) Subsection (1)(b)(III)(B) provided for the repeal of subsection (1)(b)(III), effective July 1, 2025. (See L. 2024, pp. 256, 260.)