The Division is seeking comments on the following draft proposed emergency regulation, regarding ensuring MHPAEA Compliance in the Colorado Option Standardized Health Benefit Plans:
Per Colorado Emergency Regulation 22-E-08, the Colorado Option Standardized Health Benefit Plans (Standardized Plans) must offer coverage that is compliant with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) as defined at § 10-16-102(43.5), C.R.S. To ensure MHPAEA compliance, the Division required carriers to submit the annual MHPAEA financial requirements and quantitative treatment limitations filings for their Standardized Plans by April 1, 2022. The Standardized Plan MHPAEA filing deadline is earlier than other health benefit plan annual MHPAEA filings to allow the Division to make the minimum adjustments necessary to the cost sharing structure in the Standardized Plan design if it is determined that at least one carrier’s Standardized Plan does not comply with MHPAEA financial requirements and quantitative treatment limitations.
All carriers met the April 1 filing submission deadline. The Division has completed its testing, and has determined changes are required to the Standardized Plan designs for MHPAEA compliance. In response to the required changes, the Division is releasing DRAFT Proposed Emergency Regulation 22-E-09, to replace emergency regulation 22-E-08. Emergency Regulation 22-E-08 was previously released for comment on March 17, 2022, and adopted by the Division on March 31, 2022.
Please submit your comments on this draft proposed emergency regulation no later than 5 PM, April 21, 2022, via the following link:
Required Changes to the Colorado Option Standardized Plans
- Bronze. The copay, coinsurance, and deductible did not meet the MHPAEA “substantially all” test for “Outpatient - Office Visit” classification; therefore, no cost-sharing and no deductible shall be applied to mental health/substance use disorder services in the “Outpatient - Office Visit” classification. Thus the Division adjusted the Mental/Behavioral Health/SUD Office Visit from “First 3 visits $0, then deductible, then $50” to “$0, unlimited, pre-deductible.” This reduction in cost-sharing required a $400 increase to the Maximum Out of Pocket to maintain the Federal AV.
- Silver and Gold. Per Colorado law, physical therapy, occupational therapy, and speech therapy (PT/OT/ST) for Autism Spectrum Disorders is considered a mental health benefit. The Division determined that coinsurance, rather than copay, meets the MHPAEA “substantially all” test for “Outpatient - All Other” services; therefore, any mental health services shall be subject to coinsurance rather than copay, as originally proposed in the Standardized Plan design. Thus the Division adjusted the PT/OT/ST cost-sharing from copay to coinsurance. These adjustments required a $100 increase to the Silver 87% plan deductible, and a $100 increase to the Gold plan deductible and Maximum Out-of-Pocket to maintain the Federal AV.
Impact to Permanent Rulemaking
The Division must wait for the final 2023 Federal Notice of Benefit and Payment Parameters (NBPP) and complete mental health parity testing prior to finalizing the permanent regulation for the Colorado Option Standardized Plan (Proposed New Colorado Insurance Regulation 4-2-81). With changes identified to meet mental health parity, the Division is one step closer to finalizing Proposed New Colorado Insurance Regulation 4-2-81. Once the federal government finalizes the 2023 NBPP, the Division will move forward with the permanent rulemaking process. The revised Emergency Regulation provides carriers with the necessary guidance to meet their 2023 plan filing deadlines.
This draft proposed emergency regulation, as well as other draft regulations currently released for informal public comment, can be found on the Division's Draft Regulations and Bulletins for Informal Public Comment website.