Colorado § 25.5-5-424 - Residential and inpatient substance use disorder treatment - MCE standardized utilization management process - medical necessity - report.
Full text of Colorado Colorado Revised Statutes § 25.5-5-424 — Residential and inpatient substance use disorder treatment - MCE standardized utilization management process - medical necessity - report., with citation guidance and answers to common questions.
§ 25.5-5-424. Residential and inpatient substance use disorder treatment - MCE standardized utilization management process - medical necessity - report.
(1) On or before October 1, 2021, the state department shall consult with the behavioral health administration in the department of human services, residential treatment providers, and MCEs to develop standardized utilization management processes to determine medical necessity for residential and inpatient substance use disorder treatment. The processes must incorporate the version of "The ASAM Criteria" used by the state department and align with federal medicaid payment requirements.
(2) On or before January 1, 2022, the state department shall incorporate the standards developed pursuant to subsection (1) of this section into existing MCE contracts, and each MCE shall adhere to the standards when conducting utilization management for residential and inpatient substance use disorder treatment.
(3) On or before January 1, 2022, each MCE's notice of an adverse benefit determination must demonstrate how each dimension of the version of "The ASAM Criteria" used by the state department was considered when determining medical necessity.
(4) (a) Beginning July 1, 2024, and quarterly thereafter, the state department shall report on the residential and inpatient substance use disorder utilization management statistics on the state department's website.
(I) to (III) (Deleted by amendment, L. 2024.)
(b) (Deleted by amendment, L. 2024.)
(c) Any information reported pursuant to subsection (4)(a) of this section may be aggregated as necessary to ensure confidentiality pursuant to 42 CFR part 2.
Source: L. 2021: Entire section added, (SB 21-137), ch. 362, p. 2365, § 10, effective June 28. L. 2022: (1) and IP(4)(a) amended, (HB 22-1278), ch. 222, p. 1515, § 76, effective July 1. L. 2024: (1), (3), and (4) amended, (SB 24-135), ch. 34, p. 115, § 25, effective March 22.
Cross references: For the short title ("Behavioral Health Recovery Act of 2021") and the legislative declaration in SB 21-137, see sections 1 and 2 of chapter 362, Session Laws of Colorado 2021.
Source: official Colorado text · Last verified 2026-08-27
Frequently Asked Questions About Colorado § 25.5-5-424
What does Colorado Revised Statutes § 25.5-5-424 cover?
Section 25.5-5-424 ("Residential and inpatient substance use disorder treatment - MCE standardized utilization management process - medical necessity - report.") is part of the Colorado Revised Statutes, the codified statutory law of Colorado. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
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Is this the official text of Colorado law?
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