Code of Colorado Regulations 2505 - Department of Health Care Policy and Financing
Code of Colorado Regulations – 10 CCR 2505
This set of regulations is issued by the Colorado Department of Health Care Policy and Financing (HCPF) and governs the Medical Assistance Program (Medicaid), the Children’s Basic Health Plan (CHP+), and related administrative and fiscal requirements.
The regulations are divided into two main parts:
1. Medical Services Board Rules (10 CCR 2505‑10)
These rules govern the actual delivery of health care services and Medicaid/CHP+ program operations.
Major Sections and Content:
8.000 – Medical Assistance
Defines covered services, eligibility, program rules, and transportation provisions.
Establishes rules on emergency and non-emergency medical transportation.
Sets provider payment rules and prohibits collecting payments from Medicaid clients for covered services.
Includes the Health Insurance Buy-In program for cost-effective coverage.
8.100 – Eligibility and Provider Requirements
Eligibility criteria for recipients of Medicaid/CHP+.
Provider screening and enrollment, including National Provider Identifier (NPI) requirements.
8.200 – Physician, Dental, Vision, and Other Services
Defines covered medical services.
Rules for provider responsibilities and service limitations.
8.300 – Other Services
Details coverage for additional services not included elsewhere, including behavioral health and therapies.
8.400 – Long-Term Care Services
Rules related to nursing facilities, adult day programs, and related care.
8.500 – Home and Community-Based Services (HCBS) Waivers
Services for individuals with disabilities and children with special needs.
Defines service types, eligibility, and provider responsibilities.
8.700 – Integrated Care and Behavioral Health
Rules for integrated care programs and additional service coverage.
8.900 – Provider Payment Rules
Defines fee structures, copayments, and allowable payments to providers.
Program Integrity Rules
Defines fraud, abuse, and provider obligations to prevent improper practices.
2. Executive Director Rules (10 CCR 2505‑5)
These rules focus on departmental administration, county operations, and finance.
Major Sections:
1.010 – Finance and Accounting
Rules for county and departmental fiscal management.
1.020 – County Administration
Responsibilities of county departments administering Medicaid and related programs.
1.200 – Data Reporting and Claims Database
Reporting requirements for health claims, including all-payer claims databases.
Other Administrative Rules
Incorporates federal standards by reference.
Ensures compliance with state and federal law.
Key Regulatory Topics Across CCR 2505
Eligibility – Medicaid, CHP+, and waiver programs.
Provider Enrollment – Screening, billing, and payment rules.
Covered Services – Medical, dental, behavioral health, long-term care, and HCBS.
Program Integrity – Fraud and abuse prevention.
County Responsibilities – Administration, reporting, and financial compliance.
Data Reporting – Claims, encounters, and program metrics.
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