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CO HCPF Qualified Residential Treatment Program Billing Manual — Program Benefits

ProgramBenefits

activein force · 2026-07-26 – presentas-observed

HealthFirstColoradobenefitsareprovidedthroughQualifiedResidentialTreatmentPrograms(QRTPs)toenrolledmemberswhoresideinthefacilityonaper-diembasis.HealthFirstColoradobenefitsareprovidedthroughQualifiedResidentialTreatmentPrograms(QRTPs)toenrolledmemberswhoresideinthefacilityonaper-diembasis.Theperdiemrateincludesmedicallynecessaryservicesincludedinthemember’sstabilizationplancreatedbytheQRTPinaccordanceColoradoDepartmentofHumanServices(CDHS)regulations,aswellasservicesincludedinthemember’sindividualchildandfamilyplancreatedbytheQRTPinaccordancewithCDHSregulations.Theseservicesincludebutarenotlimitedto:medicationadministrationandoversight,andindividual,group,andfamilytherapy.Servicesincludedintheperdiemratemaynotbebilledbyoutsideproviders.

ThefollowingservicesarenotcoveredformembersinaQRTP:roomandboard,educational,vocational,andjobtrainingservices,recreationalorsocialactivities,andservicesprovidedtoinmatesofpublicinstitutionsorresidentsofInstitutionsofMentalDisease(IMD).10CCR2505-108.765.

Physicalanddentalhealthservices,aswellasbehavioralhealthservicesnotincludedintheperdiemrate,suchassubstanceusedisordertreatment,maybebilledbyanoutsideprovidertotheappropriatepayor(RAEortheDepartment).10CCR2505-108.765and10CCR2505-108.280.

ChildrenandYouthMentalHealthTreatmentAct(CYMHTA)clients,whoarealsoHealthFirstColoradomembers,areassessedwiththeCYMHTAassessmentinplaceoftheEnhancedStandardizedAssessment(ESA).QRTPtreatmentforqualifyingCYMHTAclientsiseligibleforperdiemreimbursement.Providersmaysubmitclaimsasdescribedbelow.

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QRTPservicesaresubjecttoUMapproval.UMandEnhancedStandardizedAssessment(ESA)requirementsarelocatedinOperationalMemo(OM)25-032locatedonthe2025MemoSerieswebpageunder2025OperationalMemos

QRTPsareresponsibleforprovidingbehavioralmentalhealthservicestomembersresidingintheirfacilities.

ThefollowingprocedurecodescanbebilledforservicesprovidedinaQRTP:

Code

Description

Modifier

H0019

Behavioralhealth;long-termresidential,withoutroomandboard,perdiem(1unitperday)

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Behavioralhealth-relatedprescriptiondrugs.ClaimsforprescriptiondrugsaresubmittedtotheHealthFirstColoradofiscalagentundertheFFSReimbursementProgramortotheMCOforMCO-enrolledmembers.

ServicesinaPsychiatricResidentialTreatmentsFacility(PRTF).

Roomandboard

Thefollowingdaysarenotbillable:

Thedayofdischarge.

Dayswhentheclientisindetention.

Dayswhentheclientreceivesnoneoftheservicesincludedintheperdiemrateduetoelopement.

Daystheclientspendsawayfromthefacility,duetoanM1holdoratemporarypass,butstillreceivingcoveredservices,arebillableforupto4days.

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QRTPsarerequiredtosubmitallcriticalincidentreportsthatinvolveHealthFirstColorado(Colorado’sMedicaidprogram)memberstotheDepartmentofHealthCarePolicyandFinancing(theDepartment).Thisrequirementdoesnotreplaceorsupersedeanyexistingreportingrequirementsforotherstateagenciesordepartments.

Allcriticalincidents,asdefinedintheColoradoDepartmentofHumanServices(CDHS)ruleat12C.C.R.2509-8:7.701.2,mustbereportedtotheDepartmentforHealthFirstColoradomembersonly,withnon-memberinformationbeinganonymized.CDHSruleat12C.C.R.2509-8:7.701.2statesthatcriticalincidentsincludedeath,abuseandneglect,injury,illness,andemergencyresponse.Seetheruletextforfurtherdetailsandexplanation.

ProvidersmustfollowallcriticalincidentreportingandtimingrequirementsasdescribedinCDHSruleat12C.C.R.2509-8:7.701.52whenreportingtotheDepartment.CDHSruleat12C.C.R.2509-8:7.701.52statesthatcriticalincidentsmustbereportedwithin24hours,excludingweekendsandholidays,oftheoccurrenceofacriticalincidentatthefacilityorwithin24hoursofachild’sreturntothefacility.

CriticalIncidentsmustbesubmittedtotheDepartmentviatheResidentialChildcareProviderCriticalIncidentInformationForm.

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Provenance

Source: hcpf.colorado.gov
Retrieved: 2026-07-26
Edition: 2026-07-26
Content hash: 2c20c7e8b3eaeff862485bdde940e0589174131b11119f22280a998b0da471dc

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