Colorado § 25.5-4-405 - Mental health managed care service providers - requirements.

§ 25.5-4-405. Mental health managed care service providers - requirements.

(1) Each contract between the state department and a managed care organization providing mental health services to a member under the medical assistance program must comply with all federal requirements, including but not limited to:

(a) Ensuring that a member with complex or multiple needs who requires mental health services has access to mental health professionals with appropriate training and credentials and providing the member with the services in collaboration with the member's other providers;

(b) Informing each member of the member's right to and the process for appeal upon notification of denial, termination, or reduction of a requested service; and

(c) Administering initial stabilization treatment for a member and transferring the member for appropriate continued services.

(1.5) Each contract between the state department and a managed care organization providing mental health services to a member under the medical assistance program must allow for the use of telemedicine pursuant to section 25.5-5-320.

(2) For mental health managed care members, the state department shall have a patient representative program for member grievances that complies with all federal requirements and that must:

(a) Be posted in a conspicuous place at each location at which mental health services are provided;

(b) Allow for a patient representative to serve as a liaison between the member and the provider;

(c) Describe the qualifications for a patient representative;

(d) Outline the responsibilities of a patient representative;

(e) Describe the authority of a patient representative; and

(f) Establish a method by which each member is informed of the patient representative program and how a patient representative may be contacted.

Source: L. 2006: Entire article added with relocations, p. 1844, § 7, effective July 1. L. 2008: (1.5) added, p. 111, § 1, effective August 5. L. 2024: Entire section amended, (SB 24-176), ch. 152, p. 641, § 36, effective August 7.

Editor's note: This section is similar to former § 26-4-409.5 as it existed prior to 2006.