Statutes, codes, and regulations
Colorado Administrative Code
Department 2505 - Department of Health Care Policy and FinancingDivision 2505 - Medical Services Board (Volume 8; Medical Assistance, Children's Health Plan)
Rule 10 CCR 2505-10-8.200 - MEDICAL ASSISTANCE - SECTION 8.200 Physician Services, Dental, Vision Services, Medicaid Managed Care Program, EPSDT
Section 10 CCR 2505-10-8.295 - School-Based Health Center

10 Colo. Code Regs. § 2505-10-8.295

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Current through Register Vol. 47, No. 24, December 25, 2024
Section 10 CCR 2505-10-8.295 - School-Based Health Center
8.295.1Definitions
8.295.1.A. Individualized Education Plan (IEP) is defined in Section 8.290.1.
8.295.1.B. Individualized Family Service Plan (IFSP) is defined in Section 8.290.1.
8.295.1.C. School-Based Health Center (SBHC) is defined in Section 25-20.5-502(1), C.R.S (2023).
8.295.1.D. School Health Service means medical or health-related assistance provided to a member by school district employees who meet the definition of "qualified personnel" or "qualified health care professionals," as those terms are defined at Section 8.290.1, that is required for the diagnosis, treatment, or care of a physical or mental disorder and is recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under Colorado law.
8.295.2Member Eligibility
8.295.2.A. Eligible members include Colorado Medicaid enrolled members ages twenty (20) and under; and Colorado Medicaid enrolled adult members who qualify under medically necessary services.
8.295.2.B Informed and written consent by a parent or legal guardian of a student, in accordance with Section 25.5-5-318(4)(a)(I) and (II)(B), C.R.S. (2023), is required.
8.295.2.C. Confidentiality concerning eligible members, in accordance with Section 8.606, is required.
8.295.3Provider Eligibility
8.295.3.A. SBHCs must follow the enrollment requirements of their chosen provider type and specialty code. Enrolled providers are eligible to provide services in the SBHC setting if:
1. Licensed by the Colorado Department of Regulatory Agencies or the licensing agency of the state in which the provider practices, or registered with the Colorado Department of Public Health and Environment, if required by state statute, or nationally certified as a Board-Certified Behavioral Analyst; and
2. Services are within the scope of the provider's practice.
8.295.4Eligible Place of Service
8.295.4.A. Colorado Medicaid services are covered under this benefit when provided in the following places of service:
1. SBHC;
2. Office; or
3. Home/Community
8.295.5Covered Services
8.295.5.A. The scope of services provided in an SBHC is dependent upon the licensures and scopes of practice of the eligible rendering providers at that SBHC. These services may include, but are not limited to:
1. Clinical services;
2. Behavioral health services and substance use disorder services;
3. Dental services; and
4. Nutrition services.
8.295.6Prior Authorization Requirements
8.295.6.A. Prior authorization requirements for services at SBHCs are the same as those for the specific Colorado Medicaid covered service(s) being provided, and are consistent with Section 8.058.
8.295.7Non-Covered Services
8.295.7.A. The following school-based services are not covered by Colorado Medicaid:
1. Services that are already covered under another program, such as School Health Services prescribed within a child or youth's Individualized Education Plan (IEP), Individualized Family Service Plan (IFSP), other medical plan(s) of care or where medical necessity is established.
2. Services that are duplicative of care being reimbursed under another benefit or funding source.
3. Services that are not covered by Colorado Medicaid in other settings.

10 CCR 2505-10-8.295

47 CR 03, February 10, 2024, effective 3/16/2024