C.R.S. § 25.5-5-424: Residential and inpatient substance use disorder treatment - MCE standardized utilization management process - medical necessity - report.

(1) On or before October 1, 2021, the state department shall consult with the behavioral health administration in the department of human services, residential treatment providers, and MCEs to develop standardized utilization management processes to determine medical necessity for residential and inpatient substance use disorder treatment. The processes must incorporate the version of "The ASAM Criteria" used by the state department and align with federal medicaid payment requirements.

(2) On or before January 1, 2022, the state department shall incorporate the standards developed pursuant to subsection (1) of this section into existing MCE contracts, and each MCE shall adhere to the standards when conducting utilization management for residential and inpatient substance use disorder treatment.

(3) On or before January 1, 2022, each MCE's notice of an adverse benefit determination must demonstrate how each dimension of the version of "The ASAM Criteria" used by the state department was considered when determining medical necessity.

(4) (a) Beginning July 1, 2024, and quarterly thereafter, the state department shall report on the residential and inpatient substance use disorder utilization management statistics on the state department's website.

(I) to (III) (Deleted by amendment, L. 2024.)

(b) (Deleted by amendment, L. 2024.)

(c) Any information reported pursuant to subsection (4)(a) of this section may be aggregated as necessary to ensure confidentiality pursuant to 42 CFR part 2.