Behavioral Health Secure Transportation in Colorado: County Licenses, Provider Type 97, and RAE Contracts

What BHST covers in Colorado

Behavioral health secure transportation (BHST) is Colorado’s urgent ride for a person in a behavioral health crisis, under rules in effect since August 14, 2022. It covers rides from the community to a facility for evaluation, to a substance use treatment facility or a walk-in crisis center, and between facilities when a client moves to a higher or lower level of care. The behavioral health transportation guide compares Colorado’s vehicle, staffing, and training rules with other states.

Three things set BHST apart from the NEMT work you may already do:

• A different license. Counties license BHST, not the state. HB21-1085, signed June 27, 2021, also exempts it from the Public Utilities Commission.
• A different enrollment. HCPF’s BHST billing manual says NEMT and BHST need separate Medicaid enrollments. NEMT is provider type 73. BHST is provider type 97.
• A different payer. BHST rides are paid by the Regional Accountable Entities (RAEs), not by HCPF’s NEMT broker, MediDrive.

Some groups need no secure transportation license: licensed ground ambulance agencies, the Office of Behavioral Health within the Department of Human Services, emergency service patrols, and law enforcement. Rides by police are not secure transportation under the rule, and Health First Colorado does not pay for them as BHST.

How to get a county license and vehicle permits

No secure transportation service may carry a person in crisis without a license and permits from the county or counties where it is based (6 CCR 1011-4, part 3.1). “Based” means a service area in a county where you pick up clients. So a company that picks up in three counties needs three licenses, unless those counties have signed a reciprocal agreement.

Steps to a license

1. Choose your license class. Class A services may use physical restraint under the rule’s limits. Class B services may not, so they skip the restraint training, the restraint policy, and the extra equipment, such as an AED, that Class A vehicles carry.
2. Choose your vehicle type. A Type 1 permit covers a vehicle with a permanent partition between the driver and the client. A Type 2 permit covers a vehicle without one, which needs two staff on board for one client.
3. Name a manager and an administrator. Each must be at least 21, hold a high school diploma or GED, and have a year of documented supervisory experience in secure transportation or be qualified by education and experience. One person may hold both roles.
4. Buy the insurance. The rule sets the floor at vehicle insurance meeting state law with the county named as certificate holder, general and professional liability of $1,000,000 per claim and $3,000,000 for all claims, and workers’ compensation. A county can ask for more.
5. Write your policies. A county may ask for your policy and procedure manual, protocols, and training procedures. Douglas County’s checklist names a background check policy, client rights policies, a quality management program, and, for Class A, a restraint policy.
6. Apply to the county. Send its application form and fees, and have each vehicle inspected, which the rule requires every year. Douglas County also asks for a staff roster showing each person’s driver’s license number, background check result, and training.

What it costs and how long it lasts

Each county sets its own fee, and HB21-1085 lets it charge enough to cover its direct and indirect costs. As of October 2026, Douglas County charges $0 for the license, $0 for the three-year renewal, and $125 a year for each vehicle permit. Its permit packet asks for an auto insurance certificate, a mechanical inspection form signed by a licensed mechanic, and a county vehicle inspection, done through an inspection program managed by Jefferson County.

The license lasts three years and each vehicle permit one year. Neither can be sold or transferred, and a new owner must get its own license and permits before operating. File renewals at least 30 days before expiration. Tell the county in writing within 14 business days when your manager or administrator changes, and have your quality management program running within 90 days of your license.

How to enroll with Health First Colorado

Once your county license and permits are in hand, enroll with Health First Colorado (Colorado Medicaid) through HCPF’s provider enrollment portal:

• Provider type 97, Behavioral Health Secure Transportation, specialty 773, Secure Transportation.
• Licensed ambulance agencies may bill BHST under provider type 13 instead, with specialty 124 (county agency) or 324 (emergency). An ambulance agency must still meet every requirement of 6 CCR 1011-4 to be paid.

HCPF requires revalidation every five years, or sooner when a license or permit changes. You must also keep your secure transportation service profile with the Colorado Department of Public Health and Environment (CDPHE) up to date, at least once a year. The profile lists your owners and managers, staff, vehicles, counties served, and call volume.

Questions about the benefit go to HCPF’s behavioral health benefits team at hcpf_bhbenefits@state.co.us. For NEMT enrollment as provider type 73, see the Colorado state guide.

How to contract with the RAEs

Since July 1, 2025, BHST has been part of the capitation HCPF pays the RAEs, and HCPF says you must contract with the RAEs to bill. Its billing manual tells providers to send all claims and portal questions to the contracted RAE, so contract with each RAE whose members you expect to carry. HCPF lists four RAEs for the Accountable Care Collaborative’s third phase, which began July 1, 2025:

Region	RAE	Phone
1	Rocky Mountain Health Plans	800-421-6204
2	Northeast Health Partners	800-541-6870
3	Colorado Community Health Alliance	855-627-4685
4	Colorado Access	800-511-5010

Colorado Access says Region 4 covers Denver, Douglas, Adams, and Arapahoe counties. Ask each RAE’s provider network team for its contracting packet, its rate for BHST, and how it wants claims sent.

People without Medicaid are a second market. Colorado Access describes behavioral health administrative services organizations (BHASOs) as the organizations that manage non-Medicaid behavioral health funding and care coordination, and names Signal as the BHASO for Region 4. HB26-1063, in effect since August 12, 2026, requires HCPF to publish a list of secure transportation providers with managed care contracts, and the Behavioral Health Administration to publish a list of those with BHASO contracts. Each list must give an active phone number or website, so once a contract is signed, check that HCPF’s or the BHA’s list shows your dispatch number.

How BHST claims are billed and what they pay

HCPF’s State Behavioral Health Services Billing Manual for August 2026 lists two codes, and both need modifier ET:

• A0999 ET, one unit for each one-way trip.
• A0425 ET, ground mileage per statute mile.

Bill on a professional claim (837P). Use the place of service where you picked up the member. Add modifier 76 for another trip the same day by the same rendering provider, or 77 for one by a different provider. Every claim needs a diagnosis: the behavioral health crisis code from the professional who established the crisis, or R69 when you have none. Each line covers one date of service, because span billing is not allowed. A trip over 250 miles one way also needs the BHST 250+ Mileage Verification Form, completed by the behavioral health provider who asked for the ride.

What you earn is set by your RAE contract. As a benchmark, HCPF’s billing manual listed fee-for-service rates of $267.91 per one-way trip and $6.41 a mile in June 2025, just before the RAEs took over. At those rates, a 20-mile ride paid $267.91 plus $128.20, or $396.11. Compare each RAE’s offer with that figure and with your cost per trip.

HCPF’s manual, revised July 15, 2026, lists what it will not pay. The items most likely to hit a BHST company:

• Waiting time and cancellations, including calls to a location where no ride was needed.
• Charges while the member is not in the vehicle.
• Rides the member asked for directly, or rides for convenience when the member is not in crisis.
• A member who is chemically restrained or who needs medical treatment or ongoing monitoring on the way. Under the rule, a client who needs chemical restraint goes by ambulance.
• Restraint during a voluntary ride.
• Rides by law enforcement or covered by another payer.
• Hospital discharges, which Colorado pays as urgent NEMT instead. See hospital discharge transportation.

More than one member in a vehicle is not permitted under Health First Colorado, and HCPF will not pay multiple claims tied to one vehicle trip.

Records and reports you owe

The county, CDPHE, HCPF, and the RAEs can all ask for your records. HCPF’s manual requires you to keep CDPHE-required and county-required records, including restraint records, and to make them available on request.

On every ride

• Before you leave, confirm that the receiving facility will accept the client.
• During the ride, document every step from the pickup request to the drop-off, including each stop. If you use physical restraint, record the type and the times it went on and came off.
• At pickup, give the client written rights, read aloud in a language they understand when needed. The rights include notice of any video or audio recording and the right to complain to you and to the county.
• After the ride, keep a detailed trip log and any incident report.

If a ride ends in serious injury, illness, or death of a client or staff member, or a client is hurt by physical restraint, report it to the receiving facility at once and to the county within 24 hours, describing what led to it.

Every year

By March 1, send CDPHE your totals for the prior calendar year: all transports, adults and minors served, pickup and drop-off location types, clients carried more than once, rides you declined for lack of staff or vehicles, clients by home ZIP code, pickup ZIP code, gender, race, and ethnicity, and clients who were not on an involuntary hold. Add these fields to your trip log so the March report is a count, not a search. Store client records as health information, and remember that substance use treatment records carry extra federal privacy rules; see HIPAA for NEMT.

How to get BHST referrals

Members cannot book BHST themselves. A professional must establish the crisis first: an intervening professional, a crisis professional (the billing manual says skilled professional), an independent professional person, a certified peace officer, or an EMS provider. Your customers are the people who make that call.

HCPF suggests that newly enrolled providers tell these groups they are ready to serve:

1. Local 911 centers, called public safety answering points, through their administrative lines.
2. Mobile crisis response teams.
3. Emergency medical services agencies.
4. Community behavioral health providers and facilities, including emergency departments, crisis stabilization units, and walk-in crisis centers.
5. The 988 Suicide and Crisis Hotline contact, which HCPF lists as Solari. HCPF says a call to 988 can start a crisis response that may include a BHST provider.

If you do not run around the clock, the rule requires you to give each client your after-hours contact and your backup providers. Facilities that need a ride are told to call the county where the member is based, so make sure each county that licenses you has your current dispatch number. For building referral relationships with hospitals and crisis centers, see NEMT facility contracts.