C.R.S. § 25.5-1-804: State nonemergency transportation broker - transportation providers - repeal.

(1) (a) The state department may contract with a transportation broker.

(b) A transportation broker shall create a publicly available contingency plan to ensure uninterrupted NEMT services in the event the transportation broker experiences system outages or is otherwise unable to perform required functions. The transportation broker shall share the contingency plan with transportation providers.

(c) If the state department contracts with a transportation broker, the state department shall designate regions within the state for implementation of a brokered NEMT program.

(2) The transportation broker shall implement a brokered NEMT program on a phased basis, one region at a time, and shall not begin implementation in a subsequent region until the program is fully implemented in the prior region. For purposes of this section, a program is fully implemented in a region when:

(a) Technology systems for scheduling, eligibility verification, trip assignment, provider payment, and customer support are fully operational;

(b) Transportation providers in the region are provided a reasonable opportunity to complete the broker onboarding process, including provider training, system access, and required vehicle and driver verification;

(c) A sufficient network of transportation providers is available to meet members' medical needs and ensure timely access to NEMT services; and

(d) The state department has verified that provider payment processes and customer support functions operate effectively.

(3) The state department and transportation broker shall provide timely notice and technical assistance to transportation providers regarding the onboarding process. Providers may continue to complete onboarding during the implementation period.

(4) For trips originating in regions that have not yet been designated by the state department for implementation of a brokered NEMT program, transportation providers may continue to provide transportation services and bill the state department directly. Once a region has been designated for implementation of a brokered NEMT program, transportation services provided to members in that region must be scheduled and authorized through the transportation broker in accordance with state department rules.

(5) Nothing in this section limits member access to transportation services or creates service gaps during implementation of a brokered program.

(6) Transportation providers may communicate with members regarding transportation services, including trip scheduling, service delivery, and operational questions. The state department and board shall develop policies regarding when and how transportation providers can communicate with members.

(7) The state department shall develop and provide transportation providers a provider communication toolkit to assist transportation providers in discussing the transition to transportation broker control or other program changes. The provider communication toolkit must include talking points, scripts, and guidance to ensure accurate and consistent information is communicated to members. The state department shall make the provider communication toolkit available to transportation providers at least ninety days prior to the implementation of a brokered NEMT program in the region in which the provider operates.

(8) At least ninety days prior to the implementation of a brokered NEMT program in a region, the transportation broker, in coordination with the state department, shall provide training and technical support to transportation providers that provide services in the region. The state department may extend the ninety-day period as needed based on provider readiness or delays in materials or instruction. The transportation broker shall provide training and technical support to transportation providers, with support and oversight by the state department.

(9) The transportation broker shall provide all transportation providers in a brokered NEMT program region with software to facilitate NEMT services. The transportation broker shall not require transportation providers to pay the cost of software licensing, implementation, maintenance, upgrades, or training.

(10) The transportation broker may encourage a member to schedule transportation services at least two days prior to their requested transportation date. The transportation broker shall accept and make reasonable efforts to fulfill same-day and next-day transportation requests, including requests for urgent medical and behavioral health outpatient, specialty, and hospital visits; time-sensitive in-state and out-of-state transfers; and discharges from health-care facilities, when feasible, and shall not require advanced notice that would unreasonably limit access to medically necessary services. The transportation broker shall allow members to schedule single and recurring transportation services. The transportation broker shall allow members, prior to the requested transportation services, to request a transportation provider or request a different transportation provider. The transportation broker shall not direct members away from their preferred transportation provider. The transportation broker shall document and retain all provider preference requests for audit purposes. The transportation broker may only provide members the option to request a specific provider after all service regions have been implemented. The prohibition on directing members away from preferred transportation providers does not apply when the provider is subject to trip caps or market-share restrictions as part of a corrective action plan pursuant to section 25.5-1-802 (11).

(11) A transportation broker, or a transportation provider if there is no transportation broker, shall verify a member's eligibility for NEMT services immediately upon a member's request for NEMT transportation services using real-time access to the state department's eligibility system. If verification cannot be completed due to system issues or incomplete information, the transportation broker shall notify the member and the state department as soon as practicable and take action to resolve the issue promptly. Once eligibility is verified, the member is immediately eligible to schedule trips, in accordance with program rules.

(12) The transportation broker shall ensure all transportation providers meet the credentialing requirements established by state department rule. Nothing in this subsection (12) prohibits a transportation broker from imposing additional credentialing, training, or safety requirements necessary to ensure member safety, program integrity, or quality of service.

(13) (a) The transportation broker shall not operate, own, or control an NEMT transportation provider that operates in Colorado. The transportation broker shall maintain policies concerning preventing conflicts of interest and ensure that trip assignments are made consistent with safety, compliance, and operational standards. Nothing in this subsection (13) limits provider participation or imposes trip caps.

(b) A transportation broker that entered into a contract with the state department prior to January 1, 2026, to provide transportation services as a transportation provider may continue providing transportation services as a transportation provider until September 1, 2026. A transportation broker who has contracted with the state department to provide transportation services as a transportation provider and whose contract is executed, amended, or renewed on or after January 1, 2026, shall not operate, own, or control an NEMT transportation provider that operates in Colorado pursuant to subsection (13)(a) of this section.

(c) Subsection (13)(b) of this section and this subsection (13)(c) are repealed, effective January 1, 2027.

(14) The transportation broker, or the state department if there is no transportation broker, shall not restrict the number of vehicles a transportation provider can utilize or restrict the areas where or types of services a transportation provider operates.

(15) A transportation broker shall provide their trip assignment rules and procedures to the state department for approval. Upon approval, the state department shall make the transportation broker trip assignment rules and procedures publicly available on the state department's website.

(16) Transportation providers have sole authority over driver scheduling, vehicle dispatching, and driver management.

(17) NEMT drivers and vehicles must meet safety, licensing, and program compliance requirements. NEMT trips conducted by noncompliant drivers or vehicles are not eligible for reimbursement.

(18) To ensure continuity of care, transportation providers may bill the state department directly for compliant transportation services provided to members during the implementation of a brokered NEMT program in a region or in the event of transportation broker termination. Direct billing outside of these circumstances is not permitted.

(19) (a) Transportation network companies, as defined in section 40-10.1-602, may provide NEMT services if:

(I) The transportation provider originally assigned to complete a trip is unable to fulfill the assignment and no other enrolled transportation provider is available to complete the trip within the time frame necessary to ensure the member arrives at their appointment; or

(II) No transportation provider is available to serve the member in the member's county or service area at the time the trip is requested.

(b) Each use of a transportation network company in accordance with this subsection must be documented by the transportation broker in writing or an electronic record, including the reason for using the transportation network company, the reason a transportation provider was unable to complete the trip, and the date and time of the request. The transportation broker shall make the documentation available to the state department or its designee upon request for audit purposes.

(c) The transportation network company providing NEMT services must meet the driver, vehicle, safety, and credentialing requirements established by the state department for transportation network companies participating in the NEMT program, as applicable.

(20) A licensed ambulance service provider is not subject to the requirements of this section.