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 2505-10-8.770 - ABORTION SERVICES
Universal Citation: 2505 CO Code Regs 10 CCR 2505-10-8.770
Current through Register Vol. 47, No. 5, March 10, 2024
8.770.1. Definitions
Life-Endangering Circumstance means:
1. The presence of a medical condition, other
than a psychiatric condition, as determined by the attending physician, which
represents a serious and substantial threat to the life of the pregnant woman
if the pregnancy continues to term; or
2. The presence of a psychiatric condition,
which represents a serious and substantial threat to the life of the pregnant
woman if the pregnancy continues to term. In such cases, unless the pregnant
woman has been receiving prolonged psychiatric care, the attending physician
shall obtain consultation from a licensed physician specializing in psychiatry
confirming the presence of such a psychiatric condition.
8.770.2. Client Eligibility
8.770.2.A. All Colorado Medicaid-enrolled
clients are eligible.
8.770.3. Provider Eligibility
8.770.3.A. All Colorado Medicaid enrolled
providers in compliance with CRS §
25.5-3-106 are eligible to perform
abortion services.
8.770.4. Covered Services
8.770.4.A. Abortion services are only covered
when the life of the mother would be endangered if the fetus were carried to
term; or when the pregnancy is the result of an act of rape or
incest.
8.770.4.B. In cases of a
life-endangering circumstance, the physician must make every reasonable effort
to preserve the lives of the pregnant woman and the fetus.
8.770.4.C. A provider who is licensed by the
state and acting within the scope of the provider's license and in accordance
with applicable federal regulations shall perform the procedure.
8.770.4.D. Any claim for payment must be
accompanied by a case summary that includes the following information:
1. Name, address, and age of the pregnant
woman;
2. Gestational age of the
fetus;
3. Description of the
medical condition which necessitated the abortion;
4. Services performed;
5. Facility in which the abortion was
performed; and
6. Date of
service.
8.770.4.E. A
claim for payment for an abortion that is the result of life-endangering
circumstances must also be accompanied by a Department-approved certification
statement confirming the life-endangering circumstance of the abortion and at
least one of the following forms with additional supporting documentation that
confirms the life-endangering circumstances:
1. Hospital admission summary
2. The findings and reports from consultants
that provide opinions regarding the health of the client
3. Laboratory results and findings
4. Office visit notes
5. Hospital progress notes
8.770.4.F. A claim for payment for
an abortion that is the result of rape or incest must be accompanied by a
Department-approved certification statement confirming the circumstances of the
abortion.
8.770.4.G. An evaluation
by a licensed physician specializing in psychiatry must accompany the claim for
reimbursement for the abortion if a psychiatric condition represents a serious
and substantial threat to the pregnant woman's life if the pregnancy continues
to term.
8.770.5. Prior Authorization Requirements (PAR)
8.770.5.A. Prior authorization is not
required for this service.
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