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This page lists some of the action toward parity compliance undertaken by Colorado regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org.

Action in the Regulatory Arena

2017

Primary Focus: Medicaid

Agency: Department of Health Care Policy and Financing

Title/Description: 8.700.6 Reimbursement

Citation: 10 Colo. Code Regs. § 2505-10

Summary: FQHCs shall be reimbursed separate per visit encounter rates based on 100% of reasonable cost for physical health services, dental services, and specialty behavioral health services. Distinct specialty behavioral health encounters are allowable only when rendered services are covered and paid by either the Regional Accountable Entity (RAE) or through the short-term behavioral health services in the primary care setting policy.

Effective Date: July 1, 2017

 

Primary Focus: Medicaid

Agency: Department of Health Care Policy and Financing

Title/Description: 8.700.6D Encounter Rates Calculations

Citation: 10 Colo. Code Regs. § 2505-10

Summary: The annual rate for the physical health rate shall be the FQHCs current year’s audited, calculated, and inflated cost per visit for physical health services and visits. The annual rate for the specialty behavioral health rate shall be the FQHCs current year’s audited, calculated, and inflated cost per visit for behavioral health services and visits either covered and reimbursed by the RAE or by the short-term behavioral health services in the primary care setting policy.

Effective Date: July 1, 2017

2016

All health insurers in Colorado had to complete several attestation forms to qualify as a 2017 health plan. The Carrier Attestation Form requires that plans meet mental health and substance use service essential health benefit requirements. The Carrier Network Adequacy Attestation Form requires that plan’s provider networks contain a sufficient number of mental health, behavioral health, and substance use disorder providers.

11/2016

Primary Focus: Mandated Benefit: Provider

Agency: Division of Insurance

Title/Description: Section 5: Essential Health Benefits

Citation: Amended Regulation 4-2-42 as found in 3 Colo. Code Regs. § 702-4

Summary: Section 5 of Amended Regulation 4-2-42 requires carriers offering non-grandfathered individual and small group health benefit plans inside or outside of the Exchange to include the essential health benefits package, which includes mental health, substance abuse disorders, and behavioral health treatment services rendered on an inpatient or outpatient basis, among other health benefits.

Effective Date: Amended regulation effective November 1, 2016

Notes: This regulation shall apply to all carriers offering individual and small group health benefit plans subject to the individual and group laws of Colorado and the requirements of the ACA. The requirements of this regulation do not apply to grandfathered health benefit plans.

7/2016

The Division of Insurance released a proposed regulation on network adequacy standards and reporting requirements for health plans. Among many things, the proposed regulation defines mental health, behavioral health, and substance use disorder care and providers. To meet the network adequacy standards, plans must meet the following behavioral health requirements:

7/2016

The Division of Insurance released a proposed regulation on essential health benefit plan requirements for individual and small group health plans. Among many things, the regulation defines mandated mental health, substance use disorder, and behavioral healthtreatment services in inpatient and outpatient settings. These requirements include covering substance use disorder, mental health, behavioral health benefits, including partial hospitalization and inpatient treatment outside of a hospital, that are equivalent to medical and surgical benefits. Plans must also include outpatienthospital and physician services. This proposed regulation is an update to a 2013 regulation, which did not specify partial hospitalization and inpatient and outpatient settings.

4/2016

The Division of Insurance released a document titled Rate Filing Procedures for 2017. The goal of the document was to help insurers properly and efficiently submit information needed to show compliance with state and federal law and regulation on rate filing.The document states that the Division of Insurance will compare the application of quantitative treatment limitations and nonquantitative treatment limitations for specific benefits, including mental health, substance use, and behavioral health services. This section is the same as that within Rate Filing Procedures for 2016 and Rate Filing Procedures for 2015.

4/2015

The Division of Insurance released a document titled Rate Filing Procedures for 2016. The goal of the document was to help insurers properly and efficiently submit information needed to show compliance with state and federal law and regulation on rate filing. The document states that the Division of Insurance will compare the application of quantitative treatment limitations and nonquantitative treatment limitations for specific benefits, including mental health, substance use, and behavioral health services. This section is the same as that within Rate Filing Procedures for 2017 and Rate Filing Procedures for 2015.

4/2015

The Division of Insurance released a document titled Network Adequacy Filing Procedures for 2016. The goal of the document was to help insurers properly and efficiently submit information needed to show compliance with state and federal law and regulation on network adequacy. Among many things, the document requires insurers to report the number of psychologists, psychiatrists, and social workers who treat mental health and substance use disordersand the number of mental health and substance use disorderfacilities.

The Division of Insurance also provides a table with expected driving distances to mental health practitioners and facilities. Mental health practitioners should be within a 30 mile distance in urban settings and 60 mile distance in rural settings. Mental health facilities should be within a 45 mile distance in urban settings and 90 mile distance in rural settings.

2014

All health insurers in Colorado had to complete an attestation form with many requirements. One of the network adequacy requirements stated that all carriers must attest that they have a sufficient number of providers specializing in mental health and substance use disorder services.

6/2014

The Division of Insurance released a document titled Rate Filing Procedures for 2015. The goal of the document was to help insurers properly and efficiently submit information needed to show compliance with state and federal law and regulation on rate filing. The document states that the Division of Insurance will compare the application of quantitative treatment limitations and nonquantitative treatment limitations for specific benefits, including mental health, substance use disorder, and behavioral health services. This section is the same as that within Rate Filing Procedures for 2017 and Rate Filing Procedures for 2016.

5/2014

The Division of insurance released a document titled Network Adequacy Filing Procedures for 2015. The goal of the document was to help insurers properly and efficiently submit information needed to show compliance with state and federal law and regulation on network adequacy. The document highlights that networks must include a sufficient number of mental health and substance use disorder providers.

4/2014

The Division of Insurance issued a bulletin to plans about annual maximum and annual limits for applied behavior analysis for children with autism. The annual maximums were set at:

  • $34,000 for children through age 8
  • $12,000 for children age 9 through 19

The annual limits were set at:

  • 550 visits for children through age 8
  • 185 visits for children age 9 through 19

However, children can receive more than the annual limits if they have not reached the annual maximum for their respective ages.

It is not possible to provide a direct link to the full bulletin because of the design of Colorado’s Insurance Division Website. Please click here and scroll down to B-4.71 and click on that document to read this bulletin.

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:

  • schizophrenia
  • schizoaffective disorder
  • bipolar affective disorder
  • major depressive disorder
  • specific obsessive-compulsive disorder
  • panic disorder
  • post-traumatic stress disorder
  • drug and alcohol disorders
  • dysthymia
  • cyclothymia
  • social phobia
  • agoraphobia with panic disorder
  • anorexia nervosa
  • bulimia nervosa
  • general anxiety disorder

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”

Autism Coverage

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:

  • Asperger’s disorder
  • Autistic disorder
  • Pervasive developmental disorder not otherwise specified

This section defines treatment of autism as:

  • Evaluation and assessment services
  • Behavior training, behavior management, and applied behavior analysis
  • Habilitative or rehabilitative care
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care

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 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”
– Click on “10-16-104 mandatory coverage provisions”
– Scroll to section 1.4 “Autism Spectrum Disorders”

Get Support

Colorado Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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