Member Updates: HCPF Memo PM 25-005 and Retroactive RBT Requirement

Last Updated: July 31, 2025

As HCPF continues to respond to federal oversight and the implementation of Policy Memo PM 25-005 evolves, information may change quickly and without much notice. COABA will use its email alert system as the primary and most immediate way to communicate with members and providers. We strongly encourage all providers, administrators, and relevant staff to sign up for COABA alerts (found in your account details) to receive timely updates, clarification documents, guidance, and opportunities for advocacy.

On July 18, 2025, the Colorado Department of Health Care Policy & Financing (HCPF) released Policy Memo PM 25-005, which states that only Registered Behavior Technicians (RBTs) may deliver adaptive behavior treatment billed under CPT Code 97153. The memo states that it is retroactively effective to April 15, 2025, despite being publicly released months later, with no advance notice, stakeholder engagement, or implementation guidance.

Why This Matters

This memo retroactively alters qualifications for billing Medicaid services, putting providers at risk for noncompliance despite acting in good faith.
The statute cited (C.R.S. § 10-16-104) applies to commercial insurance, not Medicaid. Nevertheless, HCPF is asserting its authority to set qualifications for Medicaid-funded providers without taking any steps to collect stakeholder input and ensure sufficient numbers of RBTs are available prior to making this change. Data indicates there are not sufficient numbers of RBTs in Colorado to meet patient need.
This statewide shortage of RBTs means most providers cannot comply with the memo without disrupting medically necessary services. As a result, patient care is likely to be disrupted to detrimental effects to vulnerable children on Medicaid.

What We’re Doing

COABA and its counsel are in contact with government officials including HCPF and the State Attorneys General to address the barriers to care these retroactive changes pose. This includes retaining legal representation who drafted and sent a formal letter to challenge the legality of this memo according to the Administrative Procedures Act.
- Please consider donations toward this initiative!
Our lobbyist is coordinating with others across the behavioral health space to develop a legislative strategy (If your organization works with a lobbyist, please email publicpolicy@coaba.org or just ask your lobbyist to connect with Emma. Aligned messaging is key to successful legislative action.)
We are advocating for a sufficient grace period, protections for providers who deliver services in good faith, and a fair process that will not disrupt ongoing medical services while the issues are considered.
We are developing resources for providers, families, and stakeholders.
- FAQ Page
- Form letters to share with parents

Compliance Window

As of August 2025, HCPF has confirmed a compliance deadline of August 31, 2025, for meeting the RBT certification requirement outlined in Policy Memo PM 25-005.

According to the bulletin:

“Effective immediately, all ABA providers must ensure that any RBT providing services under their supervision is actively certified by the Behavior Analyst Certification Board (BACB)… Providers have until August 31, 2025, to come into full compliance.”

This confirms the 30-day compliance window referenced earlier. After August 31:

Only certified RBTs may provide adaptive behavior services (CPT 97153) under Medicaid billing.
Services rendered by uncertified staff must immediately cease being billed.
Providers are expected to retain verification of active RBT status and may be subject to audit or program integrity review.

📣 COABA continues to engage with HCPF and legislative stakeholders. Please be sure to sign up for COABA alerts to receive timely updates as this policy continues to evolve.

Interim Recommendations for Providers

Consult your counsel to understand how HCPF’s Policy Memo affects your agency and ongoing service delivery. We assume that given the grace period, HCPF will not be applying this requirement retroactively.
Review your staffing structure and begin identifying paths for BT credentialing as outlined in the memo.
Communicate with HCPF and encourage your client-families to communicate with HCPF if you anticipate disruptions to medically necessary services for Medicaid members.
Document your good-faith efforts to align with expectations and preserve continuity of care and/or provide notice to families of potential discharge in accordance with BACB ethical requirements (*See Draft Form Letter to Alert Clients of Potential Discharge)

⚠️ This is not legal advice. We strongly recommend each provider consult with their own legal counsel regarding risk, claims decisions, and compliance plans.

Frequently Asked Questions (FAQs)

Q1: Are services delivered between April 15 and July 18 now noncompliant?
A: Based on HCPF’s informal statement about the upcoming 30 day grace period we assume that these requirements will not be applied retroactively. |

Q2: What if I don’t have enough RBTs?
A: You are not alone. There is a statewide shortage of credentialed RBTs. Notify HCPF if this will result in client care disruptions and encourage families to contact HCPF as well.

Q3: Can I continue using trained, supervised staff who aren’t RBTs?
A: If the grace period is confirmed as HCPF has indicated, we assume you will be allowed to continue to use supervised BT level staff during this grace period.

Q4: Is this legally enforceable for Medicaid?
A: HCPF generally has the authority to set provider qualifications, however, these must be consistent with their legal obligations to ensure an adequate network of providers and the provision of EPSDT required services. There are other states that do not require this credential.

Stay Informed and Connected

Sign up for COABA alerts to stay current on developments.
Contact publicpolicy@coaba.org to share your feedback or connect your lobbyist to the coalition.
Report service disruption risks to HCPF to create a clear picture of the memo’s real-world impact.

We know this situation is placing immense pressure on providers across Colorado. Please know we are advocating hard for clarity, fairness, and a path forward that preserves access to care for the children and families who rely on it.