Code of Colorado Regulations
2505 - Department of Health Care Policy and Financing
2505 - Medical Services Board (Volume 8; Medical Assistance, Children's Health Plan)
10 CCR 2505-10-8.700 - MEDICAL ASSISTANCE - SECTION 8.700 Federally Qualified Health Centers, Women's Health Services
Section 10 CCR 2505-10-8.745 - SPECIAL CONNECTIONS
Universal Citation: 2505 CO Code Regs 10 CCR 2505-10-8.745
Current through Register Vol. 47, No. 5, March 10, 2024
8.745.1 DEFINITIONS
A. Assessment means an evaluation that is
designed to determine the level of substance use and the comprehensive
treatment needs of a pregnant member with a substance use disorder.
B. Case Management means medically necessary
coordination and planning services provided with or on behalf of a member who
is pregnant or parenting (up to child's first birthday) with a substance use
disorder. This includes treatment/service planning, linkage to other service
agencies and monitoring.
C.
Individual/Family Counseling and Therapy means planned therapeutic activity or
counseling and outlining the treatment/service plan of a member who is pregnant
or parenting (up to child's first birthday) with a substance use disorder.
Problem(s) identified by an assessment are listed in the treatment/service
plan. The intended outcome is the management, reduction/resolution of the
identified problem(s).
D. Group
Counseling means a planned therapeutic or counseling activity in a group
setting with 2 or more pregnant and parenting (up to child's first birthday)
women with substance use disorders (other than a family therapy session) in an
effort to change the individual behavior of each person in the group through
interpersonal exchange. Group services are designed to assist members with a
primary substance use disorder in achieving their treatment goals.
E. Enhanced Prenatal Care education means
services to help a member develop health and life management skills.
F. Residential Treatment means a structured
treatment program to provide therapy and treatment toward rehabilitation.
Residential Treatment Includes a planned program of professionally directed
evaluation, care and treatment for the restoration of functioning for pregnant
and parenting (up to child's first birthday) women with substance use
disorders.
8.745.2 DETERMINATION OF CLIENT ELIGIBILITY
8.745.2.A. To receive an Assessment, the
client shall be:
1. Medically verified to be
pregnant.
2. Determined either
presumptively eligible or eligible for Medicaid.
3. Self-referred or referred by a health care
practitioner as being at risk of a poor birth outcome due to substance use
during the prenatal period and in need of special assistance in order to reduce
such risk.
8.745.2.B. To
receive substance use disorder services, the client shall meet the following
conditions:
1. Received an Assessment and met
the screening criteria as determined by the Office of Behavioral Health of the
Colorado Department of Human Services.
2. Received a prior authorization from the
Office of Behavioral Health of the Colorado Department of Human
Services.
8.745.3 PROVIDER ELIGIBILITY
8.745.3.A. Eligible providers shall meet the
following criteria:
1. Be enrolled as a
Colorado Medicaid provider
2.
Contract with and obtain certification from the Office of Behavioral Health of
the Colorado Department of Human Services as a substance use disorder treatment
program for the delivery of these specialized substance use disorder
services
8.745.4 REIMBURSABLE SERVICES
8.745.4.A. Special Connections Program
services are limited to services performed by or under the supervision of
licensed clinicians or licensed health care practitioners as defined in
10 CCR
2505-10, Section 8.746.1 . Reimbursable services are:
1. One Assessment per pregnancy.
2. Substance use disorder treatment services
including case management, substance use disorder individual and family
counseling, substance use disorder group counseling, residential treatment
and/or enhanced prenatal care education.
3. Urine screening and monitoring.
8.745.4.B. Services may be
provided as outpatient or residential. Room and board are not covered
services.
8.745.5 REIMBURSEMENT
Reimbursement for services provided shall be the lowest of:
1. Submitted charges; or
2. Fee schedule as determined by the
Department.
Disclaimer: These regulations may not be the most recent version. Colorado may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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