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Part 1 - Mandatory Provisions
§ 25.5-5-101. Mandatory Provisions - Eligible Groups - Source: L. 2006: Entire article added with relocations, p. 1854,...
§ 25.5-5-102. Basic Services for the Categorically Needy - Mandated Services - Source: L. 2006: Entire article added with relocations, p. 1856,...
§ 25.5-5-103. Mandated Programs With Special State Provisions - Rules - Source: L. 2006: Entire article added with relocations, p. 1856,...
§ 25.5-5-104. Qualified Medicare Beneficiaries - Qualified medicare beneficiaries are medicare-eligible individuals with income and resources...
§ 25.5-5-105. Qualified Disabled and Working Individuals - Qualified disabled and working individuals are persons with income and...
Part 2 - Optional Provisions
§ 25.5-5-201. Optional Provisions - Optional Groups - Source: L. 2006: Entire article added with relocations, p. 1858,...
§ 25.5-5-202. Basic Services for the Categorically Needy - Optional Services - Source: L. 2006: Entire article added with relocations, p. 1860,...
§ 25.5-5-203. Optional Programs With Special State Provisions - Source: L. 2006: Entire article added with relocations, p. 1862,...
§ 25.5-5-204. Presumptive Eligibility - Pregnant Women - Children - Long-Term Care - State Plan - (2.5) A child under the age of eighteen years shall...
§ 25.5-5-204.5. Continuous Eligibility - Children - Source: L. 2009: Entire section added, (HB 09-1293), ch. 152,...
§ 25.5-5-206. Medicaid Buy-in Program - Disabled Children - Disabled Adults - Federal Authorization - Rules - Source: L. 2009: Entire section added, (HB 09-1293), ch. 152,...
§ 25.5-5-207. Adult Dental Benefit - Adult Dental Fund - Creation - Legislative Declaration - (2.5) Repealed. Source: L. 2013: Entire section added, (SB 13-242),...
§ 25.5-5-208. Additional Services - Training - Grants - Screening, Brief Intervention, and Referral - Source: L. 2015: Entire section added, (HB 15-1367), ch. 271,...
Part 3 - Services With Special State Provisions
§ 25.5-5-301. Clinic Services - (b) [ Editor's note: This version of subsection (2)(b) is...
§ 25.5-5-302. Clinic Services - Children and Pregnant Women - Utilization of Certain Providers - Source: L. 2006: Entire article added with relocations, p. 1867,...
§ 25.5-5-303. Private-Duty Nursing - Source: L. 2006: Entire article added with relocations, p. 1867,...
§ 25.5-5-304. Hospice Care - Source: L. 2006: Entire article added with relocations, p. 1868,...
§ 25.5-5-305. Pediatric Hospice Care - Legislative Declaration - Federal Authorization - Rules - Fund - Source: L. 2006: Entire article added with relocations, p. 1868,...
§ 25.5-5-307. Child Mental Health Treatment and Family Support Program - Source: L. 2006: Entire article added with relocations, p. 1872,...
§ 25.5-5-308. Breast and Cervical Cancer Prevention and Treatment Program - Creation - Legislative Declaration - Definitions - Funds - Repeal - Source: L. 2006: (8) amended, p. 1117, § 2, effective...
§ 25.5-5-309. Pregnant Women - Needs Assessment - Referral to Treatment Program - Definition - Source: L. 2006: Entire article added with relocations, p. 1875,...
§ 25.5-5-310. Treatment Program for High-Risk Pregnant and Parenting Women - Cooperation With Private Entities - Definition - Source: L. 2006: Entire article added with relocations, p. 1875,...
§ 25.5-5-311. Treatment Program for High-Risk Pregnant and Parenting Women - Data Collection - The state department, in cooperation with the department of human...
§ 25.5-5-312. Treatment Program for High-Risk Pregnant and Parenting Women - Extended Coverage - Federal Approval - Source: L. 2006: Entire article added with relocations, p. 1876,...
§ 25.5-5-314. Substance Use Disorder Treatment for Native Americans - Federal Approval - Source: L. 2006: Entire article added with relocations, p. 1876,...
§ 25.5-5-315. Acceptance of Gifts, Grants, and Donations - Native American Substance Abuse Treatment Cash Fund - Source: L. 2006: Entire article added with relocations, p. 1876,...
§ 25.5-5-316. Legislative Declaration - State Department - Disease Management Programs Authorization - Report - Source: L. 2006: Entire article added with relocations, p. 1877,...
§ 25.5-5-318. Health Services - Provision by School Districts - Repeal - Source: L. 2006: Entire article added with relocations, p. 1878,...
§ 25.5-5-319. Family Planning Pilot Program - Rules - Federal Waiver - Repeal - Source: L. 2006: Entire article added with relocations, p. 1882,...
§ 25.5-5-320. Telemedicine - Reimbursement - Disclosure Statement - Rules - Definition - Repeal - (2.1) For the purposes of reimbursement for services provided by...
§ 25.5-5-321. Telemedicine - Home Health Care - Home Health Telemedicine Cash Fund - Rules - Repeal - (I) That the patient retains the option to refuse the...
§ 25.5-5-321.5. Telehealth - Interim Therapeutic Restorations - Reimbursement - Definitions - Source: L. 2015: Entire section added, (HB 15-1309), ch. 326,...
§ 25.5-5-322. Over-the-Counter Medications - Rules - Source: L. 2010: Entire section added, (SB 10-117), ch. 227,...
§ 25.5-5-323. Complex Rehabilitation Technology - Legislative Declaration - Definitions - Source: L. 2014: Entire section added, (HB 14-1211), ch. 253,...
§ 25.5-5-324. Nonemergency Medical Transportation - Urgent and Secure Transportation Need - Report - Repeal - Source: L. 2018: Entire section added, (HB 18-1321), ch. 346,...
§ 25.5-5-325. Residential and Inpatient Substance Use Disorder Treatment - Medical Detoxification Services - Federal Approval - Performance Review Report - (I) The number of persons who received services pursuant to...
§ 25.5-5-326. Access to Clinical Trials - Definitions - Source: L. 2020: Entire section added, (HB 20-1232), ch. 266,...
§ 25.5-5-327. Eligible Peer Support Services - Reimbursement - Definitions - Source: L. 2021: Entire section added, (HB 21-1021), ch. 256,...
§ 25.5-5-328. Secure Transportation for Behavioral Health Crises - Benefit - Funding - Source: L. 2021: Entire section added, (HB 21-1085), ch. 355,...
§ 25.5-5-329. Family Planning Services - Federal Authorization -Rules - Definitions - Source: L. 2021: Entire section added, (SB 21-025), ch. 432,...
§ 25.5-5-330. Screening for Perinatal Mood and Anxiety Disorder - Source: L. 2021: Entire section added, (SB 21-137), ch. 362,...
§ 25.5-5-331. Federally Qualified Health Center - Clinical Pharmacy Services - Reimbursement - Rules - Source: L. 2021: Entire section added, (HB 21-1275), ch. 470,...
Part 4 - Statewide Managed Care System
§ 25.5-5-401. Short Title - This part 4 shall be known and may be cited...
§ 25.5-5-402. Statewide Managed Care System - Definition - Rules - Source: L. 2006: Entire article added with relocations, p. 1883,...
§ 25.5-5-403. Definitions - As used in this part 4, unless the context otherwise...
§ 25.5-5-406.1. Required Features of Statewide Managed Care System - (B) An enrollee is entitled to designate a representative, including...
§ 25.5-5-408. Capitation Payments - Availability of Base Data - Adjustments - Rate Calculation - Capitation Payment Proposal - Preference - Assignment of Medicaid Recipients - Definition - Source: L. 2006: Entire article added with relocations, p. 1893,...
§ 25.5-5-410. Data Collection for Managed Care Programs - Source: L. 2006: Entire article added with relocations, p. 1896,...
§ 25.5-5-412. Program of All-Inclusive Care for the Elderly - Services - Eligibility - Legislative Declaration - Rules - Definitions - (6) [ Editor's note: This version of the introductory portion...
§ 25.5-5-414. Telemedicine - Legislative Intent - Source: L. 2006: Entire article added with relocations, p. 1903,...
§ 25.5-5-415. Medicaid Payment Reform and Innovation Pilot Program - Legislative Declaration - Creation - Selection of Payment Projects - Report - Rules - (I) On or before February 1, 2013, concerning the design...
§ 25.5-5-418. Primary Care Provider Sustainability Fund - Creation - Use of Fund - The primary care provider sustainability fund is hereby created in...
§ 25.5-5-419. Accountable Care Collaborative - Reporting - Rules - Source: L. 2017: Entire section added, (HB 17-1353), ch. 231,...
§ 25.5-5-420. Advancing Care for Exceptional Kids - Within one hundred twenty days of the enactment of the...
§ 25.5-5-421. Parity Reporting - State Department - Public Input - Source: L. 2019: Entire section added, (HB 19-1269), ch. 195,...
§ 25.5-5-422. Medication-Assisted Treatment - Limitations on Mces - Definition - Source: L. 2019: Entire section added, (HB 19-1269), ch. 195,...
§ 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...
§ 25.5-5-424. Residential and Inpatient Substance Use Disorder Treatment - Mce Standardized Utilization Management Process - Medical Necessity - Report - Source: L. 2021: Entire section added, (SB 21-137), ch. 362,...
§ 25.5-5-425. Audit of Mce Denials for Residential and Inpatient Substance Use Disorder Treatment Authorization - Report - Source: L. 2021: Entire section added, (SB 21-137), ch. 362,...
Part 5 - Prescription Drugs
§ 25.5-5-500.3. Authorization to Bill Third Party - As a condition of doing business in the state, each...
§ 25.5-5-501. Providers - Drug Reimbursement - Source: L. 2006: Entire article added with relocations, p. 1904,...
§ 25.5-5-502. Unused Medications - Reuse - Rules - Definition - Source: L. 2006: Entire article added with relocations, p. 1904,...
§ 25.5-5-503. Prescription Drug Benefits - Authorization - Dual-Eligible Participation - Source: L. 2006: Entire article added with relocations, p. 1905,...
§ 25.5-5-504. Providers of Pharmaceutical Services - Source: L. 2006: Entire article added with relocations, p. 1905,...
§ 25.5-5-505. Prescribed Drugs - Mail Order - Rules - (1.5) The state department shall publish on its website and...
§ 25.5-5-506. Prescribed Drugs - Utilization Review - Source: L. 2006: Entire article added with relocations, p. 1906,...
§ 25.5-5-507. Prescription Drug Information and Technical Assistance Program - Rules - There is hereby created the prescription drug information and technical...
§ 25.5-5-509. Substance Use Disorder - Prescription Drugs - Notwithstanding any provisions of this part 5 to the contrary,...
§ 25.5-5-510. Pharmacy Reimbursement - Substance Use Disorder - Injections - If a pharmacy has entered into a collaborative pharmacy practice...
§ 25.5-5-511. Reimbursement for Pharmacists' Services - Legislative Declaration - Source: L. 2021: Entire section added, (HB 21-1275), ch. 470,...
§ 25.5-5-512. Pharmacy Benefit - Mental Health and Substance Use Disorders - Legislative Declaration - Source: L. 2021: Entire section added, (HB 21-1275), ch. 470,...
Part 8 - Children and Youth Behavioral Health System Improvements
§ 25.5-5-801. Legislative Declaration - Source: L. 2019: Entire part added, (SB 19-195), ch. 190,...
§ 25.5-5-802. Definitions - As used in this part 8, unless the context otherwise...
§ 25.5-5-803. High-Fidelity Wraparound Services for Children and Youth - Federal Approval - Reporting - Source: L. 2019: Entire part added, (SB 19-195), ch. 190,...
§ 25.5-5-804. Integrated Funding Pilot - Subject to available appropriations, the state department, in conjunction with...