Proposed Additional Benefits for Health Coverage Plans

Actuarial Review of Health Benefit Coverages (SB 22-040)

On June 8, 2022, Governor Polis signed Senate Bill 22-040 (SB 22-040) into law, which directs the Division to retain a contractor(s) to perform an actuarial review of potential legislative proposals that may impose a new health benefit coverage mandate on health benefit plans, or may reduce or eliminate a current coverage mandated under health benefit plans. SB22-040 also directs the Insurance Commissioner to hold a meeting to obtain stakeholder input and recommendations regarding the methodology for conducting such actuarial reviews, including specific components of the analysis, as outlined in the law.

Stakeholder Meeting - August 23, 2022

The Division invites all interested stakeholders - including representatives of the healthcare industry, consumer advocates, and other interested individuals - to a meeting on Tuesday, August 23, 2022, from 3:00 - 5:00 pm MT, to discuss potential methodologies for conducting an actuarial review of proposed health benefit coverages, pursuant to SB 22-040. Please register for the meeting by clicking on the following button: 

Register for August 23 Meeting

 

An agenda will be posted on this website prior to the meeting. If you have questions about the meeting, or the Division's implementation of SB 22-040, please contact Tara Smith at tara.smith@state.co.us or 720-701-0081.

Request for Information (RFI) - Mental Health Wellness Exam and Substance Use Disorder Coverage

On Sept. 1, 2020, the Division of Insurance issued Requests for Information (RFI) on the costs and benefits associated with requiring health insurance coverage of annual mental health wellness exam and coverage of substance use disorder (SUD). Responses to these RFIs were due to the Division on, September 30, 2020.

Proposed Mental Health Wellness Exam Benefit Proposed Substance Use Disorder (SUD) Benefit

An annual mental health wellness examination of up to sixty (60) minutes in length with a qualified mental health provider without consumer cost-sharing. The examination may include services such as the following.

  • Behavioral health screening
  • Education and consultation on healthy lifestyle changes
  • Referrals to ongoing treatment, mental health services and other supports
  • Discussion of potential options for medication

This coverage proposal derives from HB20-1086, concerning an annual mental health wellness examination. Please refer to the legislation for additional information.
  • A minimum of six physical therapy visits, six occupational therapy visits, six acupuncture visits, and six chiropractic visits (with cost sharing that is no greater than that charged for a non-preventive services primary care visit) as non pharmacological alternatives to opioid treatment; 
  • Not require prior authorization for nonpharmacological treatments as an alternative to opioids;   
  • Provide coverage for at least one atypical opioid (defined as a nonopioid analgesic with far lower fatality rates than pure opioid agonists) for the treatment of acute or chronic pain at the lower cost tier, without step therapy or prior authorization for that atypical opioid; and
  • Not require step therapy for the prescription and use of any additional atypical opioid medications for the treatment of acute or chronic pain.

These coverage proposals derive from HB20-1085, concerning prevention of SUDs. Please refer to the legislation for additional information.

 

The Division requested information on the financial impact, the health benefits of the services, and the medical efficacy of the services proposed. As part of this analysis, the Division requested information on the following.

  1. The anticipated impact on premiums in the fully insured individual, small group, and large group markets and the underlying assumptions on which the impact is based; 
  2. The anticipated impact on consumer out of pocket costs and the underlying assumptions on which the impact is based; 
  3. The anticipated impact on the total cost of health care services, including potential benefits or savings to insurers, consumers, and employers resulting from prevention or early detection of the health condition related to such coverage, and the underlying assumptions for that determination;
  4. The potential health benefits of the proposed coverage and the extent to which scientific evidence exists regarding the potential health benefits;
  5. The extent to which the proposed coverage would be a substitute for more expensive or less safe treatment;
  6. The estimated change in utilization as a result of providing the coverage;
  7. The extent to which insurance coverage for the proposed coverage already exists or, if no coverage exists, the extent to which the lack of coverage results in inadequate health care or financial hardship for Coloradans; 
  8. The extent to which the proposed benefit would result in changes to existing benefits and/or reduce access to other health benefits; and 
  9. Any other data responsive to Colorado Revised Statute Section 10-16-103 or other information that the respondent believes relevant to the analysis. 

Responses to this RFI were submitted to DORA_INS_RulesandRegulations@state.co.us.  

For questions regarding this RFI, please contact Debra Judy at debra.judy@state.co.us.

Public Meeting

On Oct. 21, 2020, the Division held a virtual public meeting to take additional comments from the public for consideration in evaluating the impacts of requiring carriers to provide these health services:

10-21-20 Public Meeting on Costs & Benefits of Requiring Health Insurance Coverage for Certain Services

Responses to Requests for Information
RFI Findings