Colorado § 25.5-1-805 - Medicaid member eligibility and verification.

§ 25.5-1-805. Medicaid member eligibility and verification.

(1) The transportation broker, or a transportation provider if there is no broker, shall ensure during scheduling that individuals who sign up to receive transportation services are members who are eligible to receive nonemergency medical transportation services.

(2) The member eligibility verification process must protect member privacy. Member eligibility verification must not require displaying a member identification card on camera or the video recording of members for routine billing purposes. Nothing in this subsection (2) prohibits the use of video recording for driver or member safety, operational monitoring, or complaint resolution purposes. The state department may request video recordings for program integrity review without advanced notice to the transportation provider, provided that requests are narrowly tailored to specific issues under review. The use of video recordings must comply with applicable privacy and confidentiality requirements. Transportation providers are not required to retain or produce video recordings beyond the standard retention period established in their operating procedures. Absence of video recordings outside a retention period does not constitute noncompliance, and adverse action shall not be taken against a transportation provider on this basis.

(3) If a transportation provider provides scheduled transportation services in good faith based on information provided by a transportation broker or the state department, the state department shall not deny payment solely because the broker or the state department later determines that the member's eligibility or trip information was inaccurate, if:

(a) The provider had no knowledge of the inaccuracy at the time of service; and

(b) The provider followed all applicable rules, procedures, and documentation requirements for claim submission.

(4) Nothing in this section alters or supersedes federal medicaid requirements. If it is later determined that a member was not eligible for medicaid at the time of service, the state department may be required to adjust or retract payment, even if the provider rendered services in good faith.

(5) The state department shall provide transportation providers with access to eligibility verification tools via the transportation broker or other authorized systems to reduce the likelihood of ineligible trips.

Source: L. 2026: Entire section added, (HB 26-1328), ch. 388, p. 2442, § 4, effective July 1.