10 Colo. Code Regs. § 2505-10-8.190

Current through Register Vol. 48, No. 1, January 10, 2025

Section 10 CCR 2505-10-8.190 - ACUTE MEDICAL BENEFITS DETERMINATION

8.190.1 A client or provider may request a coverage determination for new acute medical benefits or services by submitting a written request to the Department.

8.190.1.A. Written requests shall include documentation on all the following criteria regarding the benefit or service:

1. Prescribed by a doctor of medicine or osteopathy, or an optometrist, dentist or podiatrist acting within the scope of their respective licenses;

2. A reasonable, appropriate and effective method for meeting the medical need;

3. The expected use is in accordance with current medical standards or practices;

4. Proven cost effective method of treatment;

5. Does not result in an unsafe environment or situation;

6. Not experimental, investigational and is accepted by the medical community as standard practice;

7. Primary purpose is not to enhance personal comfort or convenience; and

8. Considered to be medically necessary for the diagnosis.

8.190.2 The requestor shall be notified in writing of the Department's decision regarding coverage.

10 CCR 2505-10-8.190