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 2505-10-8.700 - MEDICAL ASSISTANCE - SECTION 8.700 Federally Qualified Health Centers, Women's Health Services
Section 10 CCR 2505-10-8.770 - ABORTION SERVICES

10 Colo. Code Regs. § 2505-10-8.770

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Current through Register Vol. 47, No. 24, December 25, 2024
Section 10 CCR 2505-10-8.770 - ABORTION SERVICES
8.770.1.Definitions

Life-Endangering Circumstance means:

1. The presence of a medical condition, other than a psychiatric condition, as determined by the attending physician, which represents a serious and substantial threat to the life of the pregnant woman if the pregnancy continues to term; or
2. The presence of a psychiatric condition, which represents a serious and substantial threat to the life of the pregnant woman if the pregnancy continues to term. In such cases, unless the pregnant woman has been receiving prolonged psychiatric care, the attending physician shall obtain consultation from a licensed physician specializing in psychiatry confirming the presence of such a psychiatric condition.
8.770.2.Client Eligibility
8.770.2.A. All Colorado Medicaid-enrolled clients are eligible.
8.770.3.Provider Eligibility
8.770.3.A. All Colorado Medicaid enrolled providers in compliance with CRS §25.5-3-106 are eligible to perform abortion services.
8.770.4.Covered Services
8.770.4.A. Abortion services are only covered when the life of the mother would be endangered if the fetus were carried to term; or when the pregnancy is the result of an act of rape or incest.
8.770.4.B. In cases of a life-endangering circumstance, the physician must make every reasonable effort to preserve the lives of the pregnant woman and the fetus.
8.770.4.C. A provider who is licensed by the state and acting within the scope of the provider's license and in accordance with applicable federal regulations shall perform the procedure.
8.770.4.D. Any claim for payment must be accompanied by a case summary that includes the following information:
1. Name, address, and age of the pregnant woman;
2. Gestational age of the fetus;
3. Description of the medical condition which necessitated the abortion;
4. Services performed;
5. Facility in which the abortion was performed; and
6. Date of service.
8.770.4.E. A claim for payment for an abortion that is the result of life-endangering circumstances must also be accompanied by a Department-approved certification statement confirming the life-endangering circumstance of the abortion and at least one of the following forms with additional supporting documentation that confirms the life-endangering circumstances:
1. Hospital admission summary
2. The findings and reports from consultants that provide opinions regarding the health of the client
3. Laboratory results and findings
4. Office visit notes
5. Hospital progress notes
8.770.4.F. A claim for payment for an abortion that is the result of rape or incest must be accompanied by a Department-approved certification statement confirming the circumstances of the abortion.
8.770.4.G. An evaluation by a licensed physician specializing in psychiatry must accompany the claim for reimbursement for the abortion if a psychiatric condition represents a serious and substantial threat to the pregnant woman's life if the pregnancy continues to term.
8.770.5.Prior Authorization Requirements (PAR)
8.770.5.A. Prior authorization is not required for this service.

10 CCR 2505-10-8.770