reglab/housing_qa huggingface dataset:
CO Code § 10-16-137 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-137. Policy Forms - Explanation of Benefits - Standardization of Forms - Rules

  The commissioner shall convene a group of stakeholders, including carriers, providers, and consumers, to develop a standardized format for the following regarding health benefit plans, limited benefit health insurance, and dental plans:   Section names and the placement of those sections in the policy forms issued by all carriers; and    The required information for carriers to provide on an explanation of benefits form sent to covered persons or providers making a claim for benefits under a health benefit plan, limited benefit health insurance, or dental plan.       The commissioner shall adopt rules after considering the input from carriers, providers, consumers, and other stakeholders in developing the standardized format for policy forms and explanation of benefits forms. The rules shall apply to health benefit plans, limited benefit health insurance, and dental plans issued or delivered on or after January 1, 2012.     History. Source: L. 2010: Entire section added,(HB 10-1004), ch. 141, p. 477, § 1, effective August 11.
CO Code § 10-16-140 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-140. Grace Periods - Premium Payments - Rules

  For individual and small employer health benefit plans issued or renewed for coverage to begin on or after January 1, 2014, for persons receiving a subsidy under the federal act, the commissioner shall establish, by rule that complies with federal law, a requirement that all individual and small employer health benefit plans contain a provision specifying that the policyholder is entitled to a three-month grace period for the payment of any premium due, other than the first premium, during which period the plan continues in force unless the policyholder submits written notice to the carrier, prior to discontinuance of the plan in accordance with the terms of the plan, that the policyholder is discontinuing the coverage. In accordance with federal law, the commissioner's rule may provide that the policyholder is liable to the carrier for the payment of a pro rata premium for the time the coverage was in force during the grace period.    For individual and small employer health benefit plans issued or renewed for coverage to begin on or after January 1, 2014, for persons who are not receiving a subsidy under the federal act, the commissioner shall adopt a rule requiring a thirty-one-day grace period for the payment of any premium due other than the first premium.    If the covered person fails to pay all or part of the premium, the carrier shall notify the covered person of the nonpayment of premium within the grace period established pursuant to this section and in accordance with section 10-16-222, 10-16-325, or 10-16-429, as applicable.    The commissioner may adopt rules as necessary to implement and administer this section.     History. Source: L. 2013: Entire section added,(HB 13-1266), ch. 217, p. 977, § 26, effective May 13.
CO Code § 10-16-141 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-141. Medication Synchronization Services - Cost Sharing for Partial Refills - Dispensing Fees

  A carrier offering an individual or group health coverage plan in this state that provides prescription drug coverage shall offer, as part of the plan, medication synchronization services developed by the carrier that allow for the alignment of refill dates for a covered person's prescription drugs that are covered benefits.    Under its medication synchronization services, a carrier shall:   Not charge an amount in excess of the otherwise applicable copayment amount under the health coverage plan for dispensing a prescription drug in a quantity that is less than the prescribed amount if:   The pharmacy dispenses the prescription drug in accordance with the medication synchronization services offered under the health coverage plan; and    A network pharmacy dispenses the prescription drug; and       Provide a full dispensing fee to the pharmacy that dispenses the medication to the covered person.        History. Source: L. 2014: Entire section added,(HB 14-1359), ch. 221, p. 828, § 1, effective May 17.
CO Code § 10-16-142 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-142. Physical Rehabilitation Services - Copayments and Coinsurance - Research

  The Colorado commission on affordable health care created in section 25-46-103, C.R.S., shall conduct a study concerning the costs, including patient cost sharing for physical rehabilitation services. The study shall analyze costs to the health-care system, including payers and individual patients, as well as whether patient cost sharing creates barriers to the effective use of physical rehabilitation services.    On or before November 1, 2015, the commission shall report its findings to the health and human services committee of the senate and the public health care and human services committee and the health, insurance, and environment committee of the house of representatives.    For the purposes of this section, “physical rehabilitation services” means physical therapy, occupational therapy, or chiropractic services for the treatment of a person who has sustained an illness, medical condition, or injury, with the goal of returning the person to his or her prior skill and function level or maintaining the person's current skill and function level.     History. Source: L. 2015: Entire section added,(HB 15-1083), ch. 321, p. 1305, § 1, effective June 5.
CO Code § 10-16-143.5 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-143.5. Pharmacy Reimbursement - Substance Use Disorders - Injections - Patient Counseling

  If a pharmacy has entered into a collaborative pharmacy practice agreement with one or more physicians pursuant to section 12-280-602 to administer injectable antagonist medication for medication-assisted treatment for substance use disorders, the pharmacy administering the drug shall receive an enhanced dispensing fee.    If a pharmacy dispenses an opioid that is a schedule II or schedule III drug pursuant to section 18-18-204 or 18-18-205 to a patient who has not previously received an opioid prescription and the pharmacy provides counseling concerning the risk of opioids to the patient, the dispensing pharmacy shall receive an enhanced dispensing fee.    Subsection (2) of this section does not require a carrier to contract with a pharmacy or pharmacist willing to abide by the terms and conditions for participation established by the health benefit plan or carrier.     History. Source: L. 2018: Entire section added,(HB 18-1007), ch. 225, p. 1432, § 4, effective January 1, 2019. L. 2019: Entire section amended,(SB 19-228), ch. 276, p. 2601, § 1, effective May 23; entire section amended,(HB 19-1172), ch. 136, p. 1657, § 51, effective October 1.    Editor's note:   Amendments to this section by SB 19-228 and HB 19-1172 were harmonized.
CO Code § 10-16-144 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-144. Health-Care Services Provided by Pharmacists

  Any health benefit plan, except supplemental policies covering a specified disease or other limited benefit, that provides hospital, surgical, or medical expense insurance may provide coverage for health-care services under a specific treatment protocol provided by a pharmacist if:   The pharmacist meets the requirements in part 6 of article 280 of title 12;    The health benefit plan provides coverage for the same service provided by a licensed physician or an advanced practice nurse;    The pharmacist is included in the health benefit plan's network of participating providers; and    A reimbursement rate has been successfully negotiated in good faith between the pharmacist and the health plan.         A health benefit plan described in subsection (1) of this section shall provide coverage for health-care services provided by a pharmacist within a health professional shortage area, as defined in 42 U.S.C. sec. 254e, if the conditions specified in subsection (1) of this section are met.    This subsection (2) does not require a carrier to contract with a pharmacy or pharmacist willing to abide by the terms and conditions for participation established by the health benefit plan or carrier.         History. Source: L. 2016: Entire section added,(SB 16-135), ch. 239, p. 981, § 1, effective August 10. L. 2018: (2) added,(HB 18-1112), ch. 112, p. 806, § 1, effective August 8. L. 2019: (1)(a) amended,(HB 19-1172), ch. 136, p. 1657, § 52, effective October 1.
CO Code § 10-16-145 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-145. Step Therapy - Prohibited - Definition

  For the purposes of this section and section 10-16-145.5, “step therapy” means a protocol that requires a covered person to use a prescription drug or sequence of prescription drugs, other than the drug that the covered person's health-care provider recommends for the covered person's treatment, before the carrier provides coverage for the recommended prescription drug.    A carrier shall not require a covered person to undergo step therapy, and shall provide coverage for the drug prescribed by the covered person's health-care provider as long as the prescribed drug is on the carrier's prescription drug formulary, when the patient has tried the step-therapy-required prescription drugs while under his or her current or previous health insurance or health benefit plan, and such prescription drugs were discontinued due to lack of efficacy or effectiveness, diminished effect, or an adverse event. Pharmacy drug samples shall not be considered trial and failure of a preferred prescription drug in lieu of trying the step-therapy-required prescription drug.    The health carrier, health benefit plan, or utilization review organization may request relevant documentation from the patient or provider to support the override request.    This section does not preclude a carrier from requiring prior authorization for the coverage of a prescribed drug that was covered by the covered person's former health benefit plan.     History. Source: L. 2017: Entire section added,(SB 17-203), ch. 296, p. 1627, § 1, effective September 1. L. 2018: (1) amended,(HB 18-1148), ch. 109, p. 799, § 1, effective January 1, 2019.
CO Code § 10-16-145.5 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-145.5. Step Therapy Prohibited - Stage Four Advanced Metastatic Cancer - Definition

  [ ] Notwithstanding section 10-16-145, a carrier that provides coverage under a health benefit plan for the treatment of stage four advanced metastatic cancer shall not limit or exclude coverage under the health benefit plan for a drug approved by the United States food and drug administration and that is on the carrier's prescription drug formulary by mandating that a covered person with stage four advanced metastatic cancer undergo step therapy if the use of the approved drug is consistent with:   The United States food and drug administration-approved indication or the national comprehensive cancer network drugs and biologics compendium indication for the treatment of stage four advanced metastatic cancer; or    Peer-reviewed medical literature.       For the purposes of this section, “stage four advanced metastatic cancer” means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other parts of the body.    Editor's note: This version of this section is effective until January 1, 2023.  History. Source: L. 2018: Entire section added,(HB 18-1148), ch. 109, p. 799, § 2, effective January 1, 2019. L. 2021: Entire section amended,(HB 21-1276), ch. 364, p. 2396, § 3, effective January 1, 2023.    Cross references:   For the legislative declaration in HB 21-1276, see section 1 of chapter 364, Session Laws of Colorado 2021.
CO Code § 10-16-145.5 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-145.5. Step Therapy - Prior Authorization - Prohibited - Stage Four Advanced Metastatic Cancer - Opioid Prescription - Definitions

     [Editor's note: This version of this section is effective January 1, 2023.] Notwithstanding section 10-16-145, a carrier that provides coverage under a health benefit plan for the treatment of stage four advanced metastatic cancer shall not limit or exclude coverage under the health benefit plan for a drug that is approved by the FDA and that is on the carrier's prescription drug formulary by mandating that a covered person with stage four advanced metastatic cancer undergo step therapy if the use of the approved drug is consistent with:   The FDA-approved indication or the National Comprehensive Cancer Network drugs and biologics compendium indication for the treatment of stage four advanced metastatic cancer; or    Peer-reviewed medical literature.       As used in this subsection (1), “stage four advanced metastatic cancer” means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other parts of the body.         Notwithstanding section 10-16-145, a carrier that provides prescription drug benefits shall:   Provide coverage for at least one atypical opioid that has been approved by the FDA for the treatment of acute or chronic pain at the lowest tier of the carrier's drug formulary and not require step therapy or prior authorization, as defined in section 10-16-112.5 (7)(d), for that atypical opioid; and    Not require step therapy for the prescription and use of any additional atypical opioid medications that have been approved by the FDA for the treatment of acute or chronic pain.       As used in this subsection (2), “atypical opioid” means an opioid agonist with a documented safer side-effect profile and less risk of addiction than older opium-based medications.         History. Source: L. 2018: Entire section added,(HB 18-1148), ch. 109, p. 799, § 2, effective January 1, 2019. L. 2021: Entire section amended,(HB 21-1276), ch. 364, p. 2396, § 3, effective January 1, 2023.
CO Code § 10-16-146 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-146. Periodic Updates to Provider Directory

 Each carrier shall, at least every thirty days, update its provider directory as posted on the carrier's website in accordance with the information contained on the websites maintained by the applicable health-care prescriber board, as that term is defined in section 12-30-104 , to remove a provider whose license has been revoked or suspended by the applicable health-care prescriber board.   History. Source: L. 2017: Entire section added,(HB 17-1165), ch. 377, p. 1944, § 1, effective June 6. L. 2019: Entire section amended,(HB 19-1172), ch. 136, p. 1657, § 53, effective October 1.
CO Code § 10-16-148 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-148. Medication-Assisted Treatment - Limitations on Carriers - Rules - Definition

  Notwithstanding any provision of law to the contrary, beginning January 1, 2020, a carrier that provides prescription drug benefits for the treatment of substance use disorders shall, for prescription medications that are on the carrier's formulary:   Not impose prior authorization requirements on any prescription medication approved by the FDA for the treatment of substance use disorders;    Not impose any step therapy requirements as a prerequisite for coverage for a prescription medication approved by the FDA for the treatment of substance use disorders;    Place at least one covered prescription medication approved by the FDA for the treatment of substance use disorders on the lowest tier of the drug formulary developed and maintained by the carrier; and    Not exclude coverage for any prescription medication approved by the FDA for the treatment of substance use disorders and any associated counseling or wraparound services solely on the grounds that the medications and services were court ordered. (1.5) The commissioner, in consultation with the department of public health and environment, may promulgate rules or seek a revision to the prescription drug benefits required under the essential health benefits package concerning prescription medications that must be included on a carrier's formulary for medication-assisted treatment of substance use disorders.       As used in this section, “FDA” means the food and drug administration in the United States department of health and human services.     History. Source: L. 2019: Entire section added,(HB 19-1269), ch. 195, p. 2131, § 10, effective May 16. L. 2020: (1.5) added,(SB 20-007), ch. 286, p. 1391, § 8, effective July 13.    Cross references:   For the short title (“Behavioral Health Care Coverage Modernization Act”) in HB 19-1269, see section 1 of chapter 195, Session Laws of Colorado 2019.
CO Code § 10-16-149 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-149. Commissioner Report - Parity Effects on Premiums - Repeal

  By December 1, 2022, the commissioner shall submit a report to the senate health and human services committee and the house of representatives health and insurance committee and public health care and human services committee, or their successor committees, regarding the effects on premiums resulting from changes enacted by House Bill 19-1269 in required health-care coverage for the prevention of, screening for, and treatment of behavioral, mental health, and substance use disorders and network adequacy requirements for providing those services pursuant to section 10-16-104 (5.5) and (18)(b)(I) and prescription drug formulary requirements pursuant to section 10-16-148.    This section is repealed, effective March 1, 2023.     History. Source: L. 2019: Entire section added,(HB 19-1269), ch. 195, p. 2131, § 10, effective May 16.    Cross references:   For the short title (“Behavioral Health Care Coverage Modernization Act”) in HB 19-1269, see section 1 of chapter 195, Session Laws of Colorado 2019.
CO Code § 10-16-151 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-151. Cost Sharing in Prescription Insulin Drugs - Limits - Definition - Rules

  As used in this section, unless the context otherwise requires, “prescription insulin drug” means a prescription drug, as defined in section 12-280-103 (42), that contains insulin and is used to treat diabetes.    A carrier that provides coverage for prescription insulin drugs pursuant to the terms of a health coverage plan the carrier offers shall cap the total amount that a covered person is required to pay for all covered prescription insulin drugs at an amount not to exceed one hundred dollars for the covered person's entire thirty-day supply of insulin, regardless of the amount or type of insulin needed to fill the covered person's prescription or the number of prescriptions.    Nothing in this section prevents a carrier from reducing a covered person's cost sharing by an amount greater than the amount specified in subsection (2) of this section.    The commissioner may use any of the commissioner's enforcement powers to obtain a carrier's compliance with this section.    The commissioner may promulgate rules as necessary to implement and administer this section and to align with federal requirements.     History. Source: L. 2019: Entire section added,(HB 19-1216), ch. 248, p. 2419, § 2, effective August 2. L. 2021: (2) amended,(HB 21-1307), ch. 437, p. 2894, § 2, effective September 7.    Cross references:   For the legislative declaration in HB 19-1216, see section 1 of chapter 248, Session Laws of Colorado 2019. For the legislative declaration in HB 21-1307, see section 1 of chapter 437, Session Laws of Colorado 2021.
CO Code § 10-16-152 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-152. Hiv Prevention Medication - Limitations on Carriers - Step Therapy - Prior Authorization

 A carrier shall not require a covered person to undergo step therapy or to receive prior authorization before a pharmacist may, pursuant to section 12-280-125.7 , prescribe and dispense an HIV infection prevention drug.   History. Source: L. 2020: Entire section added,(HB 20-1061), ch. 281, p. 1375, § 3, effective July 13.
CO Code § 10-16-153 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-153. Coverage for Opiate Antagonists Provided by a Hospital - Definition

  As used in this section, unless the context otherwise requires, “opiate antagonist” has the same meaning as set forth in section 12-30-110 (7)(d).    A carrier that provides coverage for opiate antagonists pursuant to the terms of a health coverage plan the carrier offers shall reimburse a hospital for the hospital's cost of an opiate antagonist if the hospital gives a covered person an opiate antagonist upon discharge from the hospital.     History. Source: L. 2020: Entire section added,(HB 20-1065), ch. 287, p. 1419, § 1, effective September 14.    Editor's note:   This section was numbered as § 10-16-154 in HB 20-1065 but was renumbered on revision for ease of location.
CO Code § 10-16-154 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-154. Disclosures - Physical Therapists - Occupational Therapists - Chiropractors - Acupuncturists - Patients - Carrier Prohibitions - Enforcement

  A carrier that has a contract with a physical therapist, an occupational therapist, a chiropractor, or an acupuncturist shall not:   Prohibit the physical therapist, occupational therapist, chiropractor, or acupuncturist from providing a covered person information on the amount of the covered person's financial responsibility for the physical therapy, occupational therapy, chiropractic services, or acupuncture services provided to the covered person;    Penalize the physical therapist, occupational therapist, chiropractor, or acupuncturist for disclosing the information described in subsection (1)(a) of this section to a covered person or providing a more affordable alternative to a covered person; or    Require the physical therapist, occupational therapist, chiropractor, or acupuncturist to charge an amount to a covered person or collect a copayment from a covered person that exceeds the total charges submitted to the carrier by the physical therapist, occupational therapist, chiropractor, or acupuncturist.       If the commissioner determines that a carrier has not complied with this section, the commissioner shall require the carrier to develop and provide to the division for approval a corrective action plan or use any of the commissioner's enforcement powers under this title 10 to ensure the carrier's compliance with this section.     History. Source: L. 2021: Entire section added,(HB 21-1276), ch. 364, p. 2397, § 4, effective July 1.    Cross references:   For the legislative declaration in HB 21-1276, see section 1 of chapter 364, Session Laws of Colorado 2021.