C.R.S. § 25.5-4-218: Multiple procedure payment reductions for outpatient therapy - prohibition - definitions.

(1) As used in this section, unless the context otherwise requires:

(a) "Multiple procedure payment reduction" means a reimbursement methodology that reduces payment for one or more different services furnished to a member during the same date of service, encounter, or episode of care based solely on the number, sequencing, or combination of different services performed.

(b) "Outpatient therapy services" means professional services provided by an occupational therapist, physical therapist, or speech language pathologist in a setting other than a hospital.

(2) If the state department plans to implement, apply, or enforce a new multiple procedure payment reduction for outpatient therapy services provided under the medical assistance program, the state department must provide notice to the impacted providers of the forthcoming change at least six months prior to implementing the change to ensure adequate time for providers to prepare and hold at least one stakeholder meeting to discuss the implementation, application, and enforcement of the new multiple procedure payment reduction for outpatient therapy services. The stakeholder process must include a discussion regarding the metrics the state department plans to use in implementing the changes.