2021 Colorado Code
Title 25.5 - Health Care Policy and Financing
Article 4 - Colorado Medical Assistance Act - General Medical Assistance
Part 4 - Providers - Reimbursement
§ 25.5-4-412. Family Planning Services - Family-Planning-Related Services - Rules - Definitions

1. When family planning services or family-planning-related services are provided in accordance with this article 4 and articles 5 and 6 of this title 25.5, the executive director of the state department shall authorize reimbursement for the services, subject to section 50 of article V of the state constitution. The state department, any intermediary, or any managed care organization shall reimburse the provider of those services. Family planning services and family-planning-related services are not subject to policy deductibles, copayments, or coinsurance.
2. As used in this section, unless the context otherwise requires:
   1. “Family-planning-related services” means services provided in a family planning setting as part of or as a follow-up to a family planning visit, including:
      1. Medically necessary evaluations or preventive services, such as tobacco utilization screening, counseling, testing, and cessation services;
      2. Cervical cancer screening and prevention;
      3. Diagnosis or treatment of a sexually transmitted infection or sexually transmitted disease, and medication and supplies to prevent a sexually transmitted infection or sexually transmitted disease; and
      4. Any other medical diagnosis, treatment, or preventive service that is routinely provided pursuant to a family planning visit.

   2. “Family planning services” means all services covered by the federal Title X family planning program, regardless of an individual's age, sex, or gender identity, or the age, sex, or gender identity of the individual's partner, including but not limited to:
      1. All contraception, as defined in section 2-4-401 (1.5);
      2. Health-care and counseling services focused on preventing, delaying, or planning for a pregnancy;
      3. Follow-up visits to evaluate or manage problems associated with contraceptive methods;
      4. Sterilization services, regardless of an individual's sex; and
      5. Basic fertility services.

3. (Deleted by amendment, L. 2021.)
4. For purposes of making payments to providers, the state board shall establish rules implementing this section.
5. Any recipient may obtain family planning services or family-planning-related services from any licensed health care provider, including but not limited to a doctor of medicine, doctor of osteopathy, physician assistant, or advanced practice nurse, who provides such services. The enrollment of a recipient in a managed care organization, or a similar entity, does not restrict a recipient's choice of the licensed provider from whom the recipient may receive those services.
6. The state board shall promulgate rules establishing the specific family-planning-related services and family planning services identified in subsections (2)(a) and (2)(b) of this section. Prior to promulgating the rules, the state department shall engage in a stakeholder process that attempts to include individuals who have received family planning services through the state's medical assistance program or the children's basic health plan, representatives of consumer advocacy organizations, and family planning providers. The stakeholders must be diverse with regard to race, ethnicity, immigration status, age, ability, sexual orientation, gender identity, or geographic region of the state.

History. Source: L. 2006: Entire article added with relocations, p. 1848, § 7, effective July 1. L. 2016: (2) amended,(SB 16-158), ch. 204, p. 729, § 21, effective August 10. L. 2021: Entire section amended,(SB 21-016), ch. 428, p. 2835, § 3, effective July 6.

This section is similar to former § 26-4-414.5 as it existed prior to 2006.

For the legislative declaration in SB 16-158, see section 1 of chapter 204, Session Laws of Colorado 2016.