Colorado sets rules for Medicaid ride services and broker changes

The state department would adopt rules for the safety, oversight, credentialing, billing, and payment of Medicaid nonemergency medical transportation. The rules would cover Medicaid members, transportation providers, drivers, vehicles, and any transportation broker serving the program. The state department would work with the transportation community advisory board. Trip caps and market-share limits would generally be barred, but could be used as individualized, proportional, time-limited corrective action after notice and a chance to fix documented serious performance problems. Services by noncompliant or uncredentialed drivers or vehicles would not qualify for payment. Providers with five or fewer vehicles would not be required to use the specified video systems. The act is set to take effect July 1, 2026; specific rules and requirements would apply when adopted or otherwise implemented.

The state department may contract with a transportation broker, which would run the Medicaid ride program region by region if a contract is made. The transition would cover transportation providers and Medicaid members in regions designated for brokered service. A new region could not begin until scheduling, eligibility checks, provider payment, customer support, and other required systems work in the prior region. Providers would receive onboarding, training, technical help, and broker software without being charged for the software or training. Before a region is designated, providers could continue serving members and billing the state directly. After designation, rides would have to be scheduled and approved through the broker. The broker would have to accept reasonable efforts for same-day and next-day requests when feasible and could not require advance notice that unreasonably limits medically necessary care. The regional transition would occur one region at a time. Providers would receive the communication toolkit and training at least 90 days before brokered service begins in their region.

The state department would classify eligible Medicaid nonemergency transportation spending as medical services and seek available federal matching funds. The classification would apply to eligible nonemergency medical transportation spending and populations covered by the Medicaid program. Federal law must allow the classification and matching funds. The act does not override federal Medicaid requirements. The state department would report on the classification, federal funds, remaining unclassified spending, and needed changes. The required reports would be due November 1, 2026, and November 1, 2027. The reporting requirement would repeal January 1, 2028.