CO · guidance
CO HCPF Screening, Brief Intervention and Referral to Treatment (SBIRT) Program — Additional Policies
AdditionalPolicies
ScreeningBriefInterventionTreatmentisnotdesignedtoaddresssmokingandtobaccocessationservicesunlessitisaco-occurringdiagnosiswithanothersubstancesuchasdrugsoralcohol.Tobacco-onlyservicesarenotaSBIRTbillablebenefit.
ScreeningBriefInterventionTreatmentmustbeprovidedface-to-facewiththememberorviatelemedicine(simultaneousaudioandvideotransmissionorbytelephoneaudio-only)withthemember.
Aphysicianorder,referral,orprescriptionisnotrequiredforanycomponentofSBIRT.
Apriorauthorizationrequestisnotrequired.
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8.280.4.EOtherEPSDTBenefits
OtherhealthcareservicesmayincludeotherEPSDTbenefitsiftheneedforsuchservicesisidentified.Theservicesareabenefitwhentheymeetthefollowingrequirements:
AllgoodsandservicesdescribedinSection1905(a)oftheSocialSecurityActareacoveredbenefitunderEPSDTwhenmedicallynecessaryasdefinedat10C.C.R.2505-10,Section8.076.1.8,regardlessofwhethersuchgoodsandservicesarecoveredundertheColoradoMedicaidStatePlan.
ForthepurposesofEPSDT,medicalnecessityincludesagoodorservicethatwill,orisreasonablyexpectedto,assisttheclienttoachieveormaintainmaximumfunctionalcapacityinperformingone(1)ormoreActivitiesofDailyLiving;andmeetsthecriteriasetforthatSection8.076.1.8.b-g.
Theserviceprovidesasafeenvironmentorsituationforthechild.
Theserviceisnotfortheconvenienceofthecaregiver.
Theserviceismedicallynecessary.
Theserviceisnotexperimentalorinvestigationalandisgenerallyacceptedbythemedicalcommunityforthepurposestated.
Theserviceistheleastcostly.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
1f14cbbcadfcc9f0cbcf036c97caafb10f64eb7ce6aca9b02cabbee921d56cc2
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