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

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

(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(a) Repealed.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(2) Repealed.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.

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.

Editor's note: This section is similar to former § 26-4-203 as it existed prior to 2006.

Cross references: For the short title ("Behavioral Health Care Coverage Modernization Act") in HB 19-1269, see section 1 of chapter 195, Session Laws of Colorado 2019.