Colorado § 25.5-5-102 - Basic services for the categorically needy - mandated services - repeal.

§ 25.5-5-102. Basic services for the categorically needy - mandated services - repeal.

(1) Subject to the provisions of subsection (2) of this section and section 25.5-4-104, the program for the categorically needy must include the following services as mandated and defined by federal law:

(a) Inpatient hospital services;

(b) Outpatient hospital services;

(c) Other laboratory and X-ray services;

(d) Physicians' services, wherever furnished;

(e) Nursing facility services;

(f) Home health services;

(g) Early and periodic screening, diagnosis, and treatment, as required by federal law;

(h) Family planning, including a one-year supply of any federal food and drug administration-approved contraceptive drug, device, or product, unless the member requests a supply covering a shorter period of time;

(i) Rural health services;

(j) Advanced practice registered nurse services;

(k) and (l) (Deleted by amendment, L. 2008, p. 138, § 2, effective July 1, 2008.)

(m) Federally qualified health centers; and

(n) Nonemergency medical transportation services, as required by 42 U.S.C. sec. 1396a (a)(4)(A).

(2) In order to keep expenditures within approved appropriations, the state board may, by rule, establish limits on a service provided pursuant to this section so long as the service provided is sufficient in the amount, duration, and scope to reasonably achieve the purpose of the service as required by federal law or regulation. When a rule is promulgated pursuant to this subsection (2), the state board shall provide a summary report of the limitations established by the rule and any fiscal impact of the rule to members of the health and human services committees of the senate and house of representatives, or any successor committees, and any other members of the general assembly who request the reports.

(3) The state department shall classify nonemergency medical transportation expenditures as medical services for all eligible populations and services.

(4) The state department shall, to the extent permitted by federal law, ensure that all eligible nonemergency medical transportation expenditures classified as medical services receive available federal financial participation.

(5) On November 1, 2026, and November 1, 2027, the state department shall submit a report to the joint budget committee and the Colorado healthcare affordability and sustainability enterprise board about state savings expected or received as a result of classifying nonemergency medical transportation as a medical service. The report must include, at a minimum:

(a) The total amount of nonemergency medical transportation expenditures classified as medical services;

(b) The federal financial participation as a result of the classification;

(c) A description of actions taken to implement subsection (3) of this section, including state plan amendments, waivers, or program changes;

(d) Identification of remaining nonemergency medical transportation expenditures not yet classified as medical services and the barriers to the classification; and

(e) Recommendations for additional statutory or administrative changes necessary to maximize federal financial participation.

(6) Subsection (5) of this section is repealed, effective January 1, 2028.

Source: L. 2006: Entire article added with relocations, p. 1856, § 7, effective July 1. L. 2008: (1)(j), (1)(k), and (1)(l) amended, p. 138, § 2, effective July 1. L. 2021: (1)(h) amended, (SB 21-009), ch. 430, p. 2847, § 3, effective September 7. L. 2024: IP(1) and (1)(h) amended, (SB 24-176), ch. 152, p. 645, § 42, effective August 7. L. 2026: (1)(m) amended and (1)(n), (3), (4), (5), and (6) added, (HB 26-1328), ch. 388, p. 2444, § 6, effective July 1.

Editor's note: This section is similar to former § 26-4-202 as it existed prior to 2006.

Cross references: (1) For the definition of "federally qualified health centers" in the federal "Social Security Act", see 42 U.S.C. sec. 1395x.

(2) For the legislative declaration in SB 21-009, see section 1 of chapter 430, Session Laws of Colorado 2021.

ANNOTATION

Annotator's note. Since § 25.5-5-102 is similar to § 26-4-202 as it existed prior to the 2006 amendments relocating article 4 of title 26 to title 25.5 and § 26-4-202 is similar to § 26-4-105 as it existed prior to the 1991 repeal and reenactment of article 4 of title 26, relevant cases construing those provisions have been included in the annotations to this section.

Reimbursement for outpatient services. The state board of social services did not exceed its authority in providing reimbursement under this section for outpatient services rendered by hospital-based physicians. City of Colo. Springs v. State, 640 P.2d 870 (Colo. App. 1982).

Abortion is available for cost reimbursement. Abortion is a medical procedure which falls well within the umbrella of "basic services" listed in subsection (1), and therefore is available for cost reimbursement to the categorically needy. Dodge v. State Dept. of Soc. Servs., 657 P.2d 969 (Colo. App. 1982) (decided prior to enactment of former § 26-4-512 (now § 25.5-4-415)).