Proposed Additional Benefits for Health Coverage Plans

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. The Division will hold a virtual public meeting from 9:00 am to 11:00 am on Wednesday, October 21, 2020, to take additional comments from the public for consideration in evaluating the impacts of requiring carriers to provide these health services. For questions regarding this RFI, please contact Debra Judy at debra.judy@state.co.us.

Proposed Mental Health Wellness Exam 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.

Proposed Substance Use Disorder (SUD) Benefit

  • 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 requests information on the financial impact, the health benefits of the services, and the medical efficacy of the services proposed. The information is due to the Division on September 30, 2020. As part of this analysis, the Division has 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 should be submitted to DORA_INS_RulesandRegulations@state.co.us.  

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