Colorado Code
Part 4 - Statewide Managed Care System
§ 25.5-5-423. Independent Review Organization - Review Denial of Residential and Inpatient Substance Use Disorder Treatment Claims - Contract

No later than July 1, 2023, the state department shall contract with one or more independent review organizations to conduct external medical reviews requested for review by a medicaid provider when there is a denial or reduction for residential or inpatient substance use disorder treatment and medicaid appeals processes have been exhausted.
Source: L. 2021: Entire section added, (SB 21-137), ch. 362, p. 2364, § 9, effective June 28.
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.

Structure Colorado Code

Colorado Code

Title 25.5 - Health Care Policy and Financing

Article 5 - Colorado Medical Assistance Act - Services and Programs

Part 4 - Statewide Managed Care System

§ 25.5-5-401. Short Title

§ 25.5-5-402. Statewide Managed Care System - Definition - Rules

§ 25.5-5-403. Definitions

§ 25.5-5-406.1. Required Features of Statewide Managed Care System

§ 25.5-5-408. Capitation Payments - Availability of Base Data - Adjustments - Rate Calculation - Capitation Payment Proposal - Preference - Assignment of Medicaid Recipients - Definition

§ 25.5-5-410. Data Collection for Managed Care Programs

§ 25.5-5-412. Program of All-Inclusive Care for the Elderly - Services - Eligibility - Legislative Declaration - Rules - Definitions

§ 25.5-5-414. Telemedicine - Legislative Intent

§ 25.5-5-415. Medicaid Payment Reform and Innovation Pilot Program - Legislative Declaration - Creation - Selection of Payment Projects - Report - Rules

§ 25.5-5-418. Primary Care Provider Sustainability Fund - Creation - Use of Fund

§ 25.5-5-419. Accountable Care Collaborative - Reporting - Rules

§ 25.5-5-420. Advancing Care for Exceptional Kids

§ 25.5-5-421. Parity Reporting - State Department - Public Input

§ 25.5-5-422. Medication-Assisted Treatment - Limitations on Mces - Definition

§ 25.5-5-423. Independent Review Organization - Review Denial of Residential and Inpatient Substance Use Disorder Treatment Claims - Contract

§ 25.5-5-424. Residential and Inpatient Substance Use Disorder Treatment - Mce Standardized Utilization Management Process - Medical Necessity - Report

§ 25.5-5-425. Audit of Mce Denials for Residential and Inpatient Substance Use Disorder Treatment Authorization - Report