Source: https://www.paritytrack.org/report/colorado/colorado-law/
Timestamp: 2020-08-13 20:47:20
Document Index: 624073989

Matched Legal Cases: ['§ 10', '§ 27', '§ 27', '§ 27', '§ 25', '§ 25', '§ 25', '§ 25', '§ 25', '§ 25', '§ 25', '§ 10', '§ 10', '§ 10', '§ 10', '§ 10', '§ 10', '§ 10', '§ 10', 'art 1']

Colorado Law | ParityTrack
Statutory Overview in Colorado
Citation: Colorado Revised Statutes 10-16-102, 10-16-104, 10-16-104.8, 10-16-107, 10-16-112, 10-16-113, 10-16-124.5, 10-16-139, 10-16-147, 10-16-148, 10-16-149, 25.5-5-103, 25.5-5-402, 25.5-5-403, 25.5-5-406.1, 25.5-5-421, and 25.5-5-422
Summary: The law creates certain coverage requirements for insurers. These coverage requirements include: Providing parity-compliant MH and SUD coverage for preventative services, screening; establishing minimum coverage requirements for preventative and screening services and treatment services; and ensuring network adequacy of mental health and SUD providers. Additionally, the law creates guidelines for denial notifications of MH and SUD services.
Furthermore, the law prohibits insurers that offer prescription drug benefits for the treatment of SUD from:
The law specifies that such insurers must place at least one FDA-approved MAT medication on the lowest tier of the drug formulary.
Additionally, the law requires the Commissioner to submit an annual parity compliance report to the legislature.
Finally, the law creates additional requirements for all Medicaid plans to follow as well in order to be compliant with the Federal Parity Law and promote mental health and SUD care.
Notes: Enacted through HB19-1269
Title/Description: Substance Use Disorder Payment And Coverage
Citation: Colorado Revised Statues 10-16-104(5)(a)(III); 10-16-121(1)(e); 10-16-124.5(8)(b); 10-16-143.5; 25.5-5-411(4)(b); 25.5-5-509; 25.5-5-510
Summary: Among many things, this law added sections to requires all insurers to provide coverage for a five day supply of first requests for Buprenorphine without prior authorization. Additionally, the law requires the Colorado Medical assistance program to authorize, without prior approval, at least one FDA-approved ready-to-use opioid reversal drug. Additionally, the law prohibits the use of financial incentives to providers based solely on patient satisfaction surveys relating to pain treatment. Finally, the law requires state agencies to establish rules that standardize utilization management authority timelines for non-pharmaceutical components of MAT.
Notes: Enacted through HB 18
Title/Description: Parity Reporting – Commissioner – Definition
Citation: Colo. Rev. Stat. § 10-16-147
Summary: The commissioner shall submit a written report and provide a presentation of the report to the general assembly that:
(I) Specifies the methodology the commissioner uses to verify that carriers are complying with Colorado’s insurance coverage statutes and regulations and with the Mental Health Parity and Addition Equity Act;
(II) Identifies market conduct examinations initiated, conducted, or completed during the preceding twelve months regarding compliance with Colorado’s insurance coverage statutes and regulations and with the Mental Health Parity and Addition Equity Act, and summarizes the outcomes of those market conduct examinations;
(III) Details any educational or corrective actions the commissioner has taken to ensure carrier compliance with Colorado’s insurance coverage statutes and with the Mental Health Parity and Addition Equity Act.
Note: Enacted through HB 1357 (2018 Regular Session)
Primary Focus: Access to Behavioral Health Services
Title/Description: Increasing Access to Effective Substance Use Disorder Services Act
Citation: COLO. REV. STAT. § 27-80-107.5
Summary: COLO. REV. STAT. § 27-80-107.5 established requirements to assess the sufficiency of substance abuse programs. In 2017, managed service organizations are required to:
(1) Assess the sufficiency of substance use disorder services within geographic regions for adolescents ages seventeen and younger, young adults ages eighteen through twenty-five, pregnant women, women who are postpartum and parenting, and other adults who are in need of such services;
(2) Seek input from community mental health centers, behavioral health organizations, county departments of human or social services, law enforcement, and other relevant stakeholders;
(3) Create a community action plan summarizing the results of the community assessment and include a description of how the managed service organization will address service gaps;
(4) Designate and disburse funding to each managed service organization that has submitted an action plan;
(5) Submit an annual report to the department concerning the amount and purpose of actual expenditures.
Moreover, The Department of Human Services shall submit a report to the joint budget committee and the joint health and human services committee by November 1, 2020.
Effective Date: Amendments effective August 9, 2017
Notes: COLO. REV. STAT. § 27-80-107.5 was initially enacted through SB 16-202 and amended in 2017 by SB 17-234.
Primary Focus: Reimbursement and Service Limits in Behavioral Health Care
Title/Description: Cross-System Response for Behavioral Health Crises Pilot Program
Citation: COLO. REV. STAT. § 25.5-6-412
Summary: COLO. REV. STAT. § 25.5-6-412 recognizes that there is inadequate reimbursement and inappropriate service limits in the behavioral health capitated system as well as medical mental health benefits in the Colorado fee-for-service Medicaid state plan. As such, the statute aims to address the problem of limited access to appropriate treatment in the behavioral health system, including crisis intervention, stabilization, and prevention. To address these issues, COLO. REV. STAT. § 25.5-6-412 establishes a pilot program and associated fund to provide a cross-system response to behavioral health crises.
(1) Provide access to intensive coordinated psychiatric, behavioral, and mental health services for crisis intervention as an alternative to emergency department care or in-patient hospitalization;
(2) Offer community-based, mobile supports to individuals with dual diagnoses and their families;
(3) Offer follow-up supports to individuals with dual diagnoses, families, and caregivers to reduce the likelihood of future crises;
(4) Provide education and training for families and service agencies;
(5) Provide data about the cost in Colorado of providing such services throughout the state to complement the cost-analysis study described in subsection (6) of this section related to the cost to eliminate service gaps for individuals who have an intellectual and developmental disability and who also have a behavioral or mental health disorder; and
(6) Provide data about systemic structural changes needed to remove existing regulatory or procedural barriers to the authorized use of public funds across systems, including the Medicaid state plan, home- and community-based service Medicaid waivers, the capitated mental health care system, and the Colorado behavioral health crisis response system.
Notes: COLO. REV. STAT. § 25.5-6-412 was initially enacted through HB 15-1368 and subsequently amended through SB 17-242.
Primary Focus: Substance Use Disorder Treatment in Medicaid Program
Title/Description: Feasibility Study – Residential and Inpatient Substance Use Disorder Treatment
Citation: COLO. REV. STAT. § 25.5-4-214
Summary: COLO. REV. STAT. § 25.5-4-214 requires the state department to prepare a report concerning the feasibility of providing residential and inpatient substance use disorder treatment as part of the Medicaid program. In conducting their assessment, the state department must consider:
(1) The prevalence of opioid addiction and other substance use disorders in Colorado, including demographic and geographic information;
(2) A description of residential and inpatient substance use disorder treatment and a comparison of the treatment costs and administrative costs of providing the service utilizing Medicaid dollars or with state funding;
(3) Residential and inpatient substance use disorder treatment that is not currently included in Colorado’s state Medicaid plan but that may be provided by the state as an optional benefit or through a federal waiver;
(4) Any federal authorization necessary to include residential and inpatient substance use disorder treatment as a benefit under the Medicaid program or waiver of federal rules that would allow for expansion of residential and inpatient treatment;
(5) An estimate of the number of Medicaid clients who may be eligible for the benefit if the benefit were included as part of the Medicaid program;
(6) Whether facilities currently providing residential and inpatient substance use disorder treatment in Colorado would be able to provide those services under the Medicaid program;
(7) An estimate of state costs associated with providing residential and inpatient substance use disorder treatment as part of the Medicaid program;
Notes: COLO. REV. STAT. § 25.5-4-214 was created by HB 17-1351.
Title/Description: Substance Use Disorders—Court-Ordered Treatment Coverage
Citation: Colo. Rev. Stat. § 10-16-104.7
Summary: An individual or group health benefit plan that provides coverage for substance use disorder treatment must provide that coverage regardless of whether the treatment is voluntary or court-ordered. The health benefit plan is only responsible for those benefits that are covered by the health benefit plan and not those that are court-ordered that exceed the scope of benefits as provided by the health plan.
Colo. Rev. Stat. § 10-16-104.7 also states that nothing in this section mandates or is meant to construe that any health benefit plan must provide coverage for treatment of a substance use disorder.
Note: Enacted though SB 242 (2017 Regular Session)
Title/Description: Behavioral, Mental Health, or Substance Use Disorder Services Coverage—Court Ordered
Citation: Colo. Rev. Stat. § 10-16-104.8
Summary: An individual or group health benefit plan that provides coverage for behavioral, mental health, or substance use disorder services must provide that coverage regardless of whether the services are voluntary or court-ordered. The health benefit plan is only responsible for those benefits that are covered by the health benefit plan and not those that are court-ordered that exceed the scope of benefits as provided by the health plan.
Colo. Rev. Stat. § 10-16-104.8 also provides definitions that are applicable to this subsection.
Title/Description: Benefits for Care in Tax-Supported Institutions—Behavioral Health Disorders—Mental Health Disorders—Intellectual and Developmental Disabilities
Citation: Colo. Rev. Stat. § 10-16-219
Summary: Individual or group or small group policies of sickness, health, or accident insurance that provides coverage for behavioral or mental health disorders or intellectual and developmental disabilities must not exclude or diminish benefits for the payment of the direct costs, related to the treatment of such behavioral or mental health disorders or intellectual and developmental disabilities, provided by a state institution.
Effective Date: Amendment effective May 25, 2017.
Notes: Enacted though SB 242 (2017 Regular Session)
Title/Description: Mandatory Coverage Provisions—Definitions—Rules
Citation: Colo. Rev. Stat. § 10-16-104
Summary: All health benefit plans must provide coverage for the assessment, diagnosis, and treatment of autism spectrum disorders for a child. Unless the policy meets some exception, the coverage shall not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally.
Colo. Rev. Stat. § 10-16-104 also mandates that every health benefit plan, unless it meets some exception, must provide coverage for the treatment of both biologically based mental health disorders and behavioral, mental health, or substance use disorders that is no less extensive than the coverage provided for a physical illness.
Colo. Rev. Stat. § 10-16-104 continues on to discuss coverage for newborn children, maternity care, diabetes, dependent children, adopted children, prosthetic devices, vaccines and preventive health services, and other services.
Effective Date: Amendment effective May 25. 2017.
Sponsor: Sen. Steadman and Rep. Young
Summary: This bill removes the Medicaid $25,000 annual dollar limit for services that may be provided to a child 8 years and under in the autism waiver program. Instead, medical services will be set annually based upon the general assembly’s appropriations.
Sponsor: Sen. Kefalas and Rep. Primavera
Summary: This bill changed sections of state law relative to autism coverage by doing the following:
Clarifies that medically necessary treatment must be covered
Adds autism spectrum disorder to the list of “biologically-based mental illness and mental disorders” that plans must cover (see the other conditions on the list at the bottom of this page in “Colorado Parity Law” section)
Removes language allowing the Commissioner of the Division of Insurance to set a visit limit for autism services
Repeals a section of the law about autism coverage that is no longer relevant
Sponsor: Rep. McCann and Sen. Aguilar
Summary: Among many other things, this bill changed the parity sections of the state insurance law in the following ways:
Requires small employer fully-insured plans to cover all of the conditions that are specifically listed in this section of the law
Adds anorexia and bulimia to the conditions listed in this section of the law
Removes language that had allowed plans to use utilization review for behavioral health services even if they did not use it for other medical services
Authorizes the Commissioner of the Division of Insurance to issue rules about plan compliance with this section and relevant federal laws
Applies the section about court-ordered mental health treatment coverage to include post-traumatic stress disorder, drug and alcohol disorders, dysthymia, cyclothymia, social phobia, agoraphobia with panic disorder, anorexia nervosa, bulimia nervosa, and general anxiety disorder
Repeals a less favorable parity section that applied to small employer fully-insured plans
Sponsor: Sen. Shaffer and Rep. Primavera
Summary: This bill added the section about autism coverage to the state insurance law. Please scroll to the bottom of the page to read about this section of the law.
SB 1338 from this session had a provision that was relevant to parity. However, we have decided not to summarize this bill because it amended a section of the insurance law about parity that has since been repealed. The section that was repealed applied to small employer fully-insured plans. The bill that repealed this section (HB 1266 from 2013) made the parity section of the insurance law summarized below apply to small employer fully-insured plans.
Colorado Parity Law
Behavioral Health Coverage Section
This section of the law requires large employer fully-insured plans,small employer fully-insured plans, and individual plans to provide coverage for certain behavioral health conditions that is “no less extensive than coverage provided for physical illness.”
This section also requires that plans use prior authorization and utilization review for behavioral health services the same way or no more restrictively than they do for other medical services.
The law applies to the following conditions:
autism (effective January 1, 2017)
This section requires the Commissioner of the Division of Insurance to issue rules for implementing this section of the law. This section also authorizes the Commissioner to issue rules to ensure that plans comply with Federal Parity Law when complying with this section of the law.
Another section of the law requires plans to provide this coverage for substance use disorders no matter whether the services are voluntary or court ordered.
Another section of the law requires plans to provide this coverage for mental health conditions no matter whether the services are voluntary or court ordered.
It is not possible to provide direct links to the sections of the law mentioned above. Please follow these instructions to find the specific sections of the law:
– Click here to access the laws of Colorado
– Click on “Colorado Revised Statutes” on the upper right part of the page
– Click on the plus sign next to “Title 10”
– Click on the plus sign next to “health care coverage”
– Click on the plus sign next to “article 16”
– Click on the plus sign next to “part 1”
– To find the section that requires coverage and lists conditions: Click on “10-16-104 mandatory coverage provisions” and scroll down to section 5.5 (about halfway down the page)
– To find the section that requires coverage for court-ordered substance use treatment: Click on “10-16-104.7 substance abuse – court-ordered treatment coverage”
– To find the section that requires coverage for court-ordered mental health treatment: Click on “10-16-104.8 mental health services coverage – court ordered”
This section requires large employer fully-insured plans and small employer fully-insured plans to cover autism services for children. Although no age limit is specified, the fact that this section specifically says that plans must cover “treatment of autism spectrum disorders for a child,” it is reasonable to conclude it does not apply coverage to anyone 18 years of age or older.
Autism spectrum disorder is defined as:
This section defines treatment of autism as:
Behavior training, behavior management, and applied behavior analysis
All of these forms of care are defined in detail within this section of the law.
All annual maximums, lifetime maximums, deductibles, and coinsurance must be the same as what are in place for other medical services.
– Click on “10-16-104 mandatory coverage provisions”
– Scroll to section 1.4 “Autism Spectrum Disorders”