Colorado

Liver damage restrictions

Effective January 1, 2018, the Fee-For-Service (FFS) and Primary Care Case Management System (PCCM) have no minimum liver damage requirement for accessing treatment. The Managed Care Organization (MCO), Denver Health Medicaid Choice, does not have any liver damage requirements.

Sobriety restrictions

FFS and PCCM require screening and counseling for sobriety; for members abusing/misusing alcohol or controlled substances, members must be receiving or be enrolled in counseling or a substance use treatment program for at least 1 month prior to starting treatment. The MCO (Denver Health Medicaid Choice) also requires screening and counseling for alcohol and substance use.

Prescriber restrictions

FFS and PCCM require a prescription to be written by or in consultation with a specialist. The MCO (Denver Health Medicaid Choice) also requires a prescription to be written by or in consultation with a specialist.

Recommendations

• Remove mandatory counseling or substance use treatment requirement to start treatment or allow simultaneous treatments.
• Remove prescriber requirements.
• Maintain transparency regarding hepatitis C coverage criteria and ensure coverage parity between FFS and MCO programs.