Behavioral, mental health, and substance use disorders - parity in coverage - private insurance - medicaid - coverage of medication-assisted treatment - parity reporting requirements - compliance with federal law - complaints from ombudsman for behavioral health access to care - rules - appropriation. The act enacts the "Behavioral Health Care Coverage Modernization Act" to address issues related to coverage of behavioral, mental health, and substance use disorder services under private health insurance and the state medical assistance program (medicaid). With regard to health insurance, the act: Specifies that mandatory insurance coverage for behavioral, mental health, and substance use disorders includes coverage for the prevention of, screening for, and treatment of those disorders and must comply with the federal "Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008" (MHPAEA) (section 3 of the act); Requires services for behavioral, mental health, and substance use disorders to continue while a claim for coverage of those services is under review until the carrier notifies the covered person of the determination on the claim (section 3); Requires carriers to comply with treatment limitation requirements specified in federal regulations and precludes carriers from applying nonquantitative treatment limitations to behavioral, mental health, and substance use disorder services that do not apply to medical and surgical benefits (section 3); Requires carriers to establish procedures to authorize treatment by nonparticipating providers when a participating provider is not available under network adequacy requirements and to reimburse treatment or services for behavioral, mental health, or substance use disorders obtained from a nonparticipating provider because the covered service was not available within established time and distance standards using the same methodology the carrier uses to reimburse covered medical services provided by nonparticipating providers (section 3); Requires the commissioner of insurance (commissioner) to adopt rules to establish reasonable time periods for visits with a provider for treatment of a behavioral, mental health, or substance use disorder after an initial visit with a provider (section 3); Modifies the definition of "behavioral, mental health, and substance use disorder" to include diagnostic categories listed in the mental disorders section of the International Statistical Classification of Diseases and Related Health Problems, the Diagnostic and Statistical Manual of Mental Disorders, or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (section 3); Updates the required coverage related to alcohol use and behavioral health screenings to reflect the current requirements of that coverage as specified in recommendations of the United States preventive services task force (section 3); Requires the commissioner to disapprove a carrier's requested rate increase for failure to demonstrate compliance with the MHPAEA in accordance with rules adopted by the commissioner (section 5); For purposes of denials of reimbursement for behavioral, mental health, or substance use disorder services, other than denials based on nonpayment of premiums, requires carriers to include specified information about the protections included in the MHPAEA, how to contact the division of insurance or the office of the ombudsman for behavioral health access to care (office) related to possible violations of the MHPAEA, and the right to request medical necessity criteria from the carrier free of charge (section 6); For health benefit plans issued or renewed on or after January 1, 2020, requires carriers that provide coverage for an annual physical examination as a preventive health care service to also cover and reimburse for behavioral health screenings using a validated screening tool for behavioral health to the same extent the physical examination is covered (section 8); Requires carriers to submit an annual parity report to the commissioner and requires the commissioner to examine complaints received from the office regarding compliance with the requirements of the act or the MHPAEA upon the request of the office (section 9); Starting January 1, 2020, for a carrier that provides prescription drug benefits for the treatment of substance use disorders, with regard to prescription medications that are on the carrier's formulary, requires the carrier to provide coverage of any FDA-approved prescription medication for treating substance use disorders without prior authorization or step therapy requirements and to place at least one covered substance use disorder prescription medication on the lowest tier of the drug formulary, and precludes those carriers from excluding coverage for those medications and related services solely on the grounds that they were court ordered (section 10); and Requires the commissioner to provide a report by December 1, 2022, to specified legislative committees regarding the effects of the act on premiums (section 10). With regard to medicaid, the act: Requires the department of health care policy and financing (department) to ensure that medicaid covers behavioral, mental health, and substance use disorder services to the extent that medicaid covers a physical illness and complies with the MHPAEA (section 11); Requires the medical services board (state board) to establish a procedure, by rule, to allow for reimbursements of medically necessary state plan behavioral, mental health, or substance use services under medicaid when a managed care entity (MCE) denies coverage of the service based on diagnosis (section 11); Requires the statewide system of community behavioral health care in the managed care system to require MCEs to provide an adequate network of providers of behavioral, mental health, and substance use disorder services and to cover all medically necessary covered treatments for covered behavioral health diagnoses, regardless of any co-occurring conditions (section 12); Requires the department to include utilization management guidelines for the MCEs in state board managed care rules and to provide information on its website specifying how the public may request the network adequacy plans and quarterly network reports for an MCE (section 12); Requires the department to examine complaints received from the office regarding compliance with the requirements of the act or the MHPAEA upon the request of the office (section 12); Requires MCEs to include specified statements regarding the applicability of the MHPAEA to the managed care system in medicaid and how to contact the office regarding possible violations of the MHPAEA (section 14); Requires the department to submit an annual parity report to specified legislative committees and to contract with an external quality review organization annually to monitor MCEs' utilization management programs and policies to ensure compliance with the MHPAEA (section 15); and Starting January 1, 2020, requires an MCE that provides prescription drug benefits for the treatment of substance use disorders to provide coverage of any FDA-approved prescription medication for treating substance use disorders without prior authorization or step therapy requirements and precludes those MCEs from excluding coverage for those medications and related services solely on the grounds that they were court ordered (section 15). The act appropriates $167,000 to the department of health care policy and financing and $88,248 to the department of regulatory agencies to implement the act. (Note: This summary applies to this bill as enacted.) Read More
Wraparound services - child and youth behavioral health delivery system pilot program - standardized screening tools - single statewide referral and entry point - children and youth at risk of out-of-home placement or in an out-of-home placement - appropriation. No later than July 1, 2020, the department of health care policy and financing shall seek federal authorization to provide wraparound services for eligible children and youth who are at risk of out-of-home placement or in an out-of-home placement. Upon federal authorization, the department of health care policy and financing shall require managed care entities to implement wraparound services, which may be contracted out to a third party. The act requires the department of health care policy and financing, in conjunction with the department of human services, to develop and implement wraparound services for children and youth at risk of out-of-home placement or in an out-of-home placement. The act requires wraparound services to be covered under medicaid. Upon implementation of the wraparound services, the department of health care policy and financing and the department of human services shall monitor and report the annual cost savings associated with eligible children and youth receiving wraparound services to the public through the annual "SMART Act" hearing. No later than July 1, 2020, the department of health care policy and financing is required to design and recommend a child and youth behavioral health delivery system pilot program that addresses the challenges of fragmentation and duplication of behavioral health services. The act requires the executive director of the department of human services to appoint two full-time staff persons to support and facilitate interagency coordination for the development and implementation of wraparound services. No later than July 1, 2020, the department of human services is required to select a single standardized assessment tool to facilitate identification of behavioral health issues and develop a plan to implement the tool for programmatic utilization. The act also requires the department of human services to select developmentally appropriate and culturally competent statewide behavioral health standardized screening tools for primary care providers, which may be made available electronically for health care professionals. The department of public health and environment shall ensure adequate statewide training on the standardized screening tools for primary care providers and other interested health care professionals who care for children. No later than July 1, 2020, the department of human services, in conjunction with the department of health care policy and financing and the department of public health and environment, is required to develop a plan for establishing a single statewide referral and entry point for children and youth who have a positive behavioral health screening or whose needs are identified through a standardized assessment. The act makes multiple appropriations to the department of health care policy and financing and the department of human services. (Note: This summary applies to this bill as enacted.) Read More
High schools - accelerated college opportunity exam fee grant program. The act renames the advanced placement exam fee grant program as the accelerated college opportunity exam fee grant program (grant program) and expands the grant program to make funds available to high schools to reduce or eliminate the international baccalaureate exam fee for low-income students. The department of education is not required to award all grants from the program in the same amount, but a grant awarded for a lesser amount must cover the entire cost of the exam fee for which the lesser grant is awarded.(Note: This summary applies to this bill as enacted.) Read More
Health insurance - required coverage - breast cancer screening with noninvasive imaging. The act requires health care coverage for breast cancer screening studies and subsequent breast imaging using the noninvasive imaging modality appropriate for each individual, as determined by the individual's health care provider, and within the appropriate use guidelines as determined by the American College of Radiology or the National Comprehensive Cancer Network. The act applies to policies and contracts issued or renewed on or after January 1, 2021. (Note: This summary applies to this bill as enacted.) Read More
Regulation of insurance companies - corporate governance annual disclosures. The act establishes, with amendments, certain model laws of the National Association of Insurance Commissioners concerning corporate governance annual disclosures (CGADs) by insurers and insurance groups (insurers). On June 1, 2020, and on June 1 of each year thereafter, an insurer shall submit to the commissioner of insurance (commissioner) a CGAD that contains sufficient information to permit the commissioner to gain and maintain an understanding of the insurer's corporate governance framework. The act establishes confidentiality requirements for the commissioner and any third-party consultants retained by the commissioner. The act states that any insurer that fails, without just cause, to timely file a CGAD shall pay, after notice and a hearing, a penalty of $200 for each day's delay. The maximum penalty is $25,000. The act allows the commissioner to act as the group-wide supervisor for an internationally active insurance group or to designate or acknowledge another regulatory official as the group-wide supervisor for an internationally active insurance group that: Does not have substantial insurance operations in the United States; Has substantial insurance operations in the United States, but not in Colorado; or Has substantial insurance operations in the United States and in Colorado, but the commissioner has determined pursuant to certain criteria that the other regulatory official is the appropriate group-wide supervisor. The act describes certain permissible supervisory activities for the commissioner to perform while acting as a group-wide supervisor of an internationally active insurance group. (Note: This summary applies to this bill as enacted.) Read More
Emergency management - resiliency office - continuation - appropriation. The act continues the Colorado resiliency office, which administers the resiliency and community recovery program as part of the state's disaster recovery and response functions. The requirement that the office be funded solely through grant funding is repealed, making general funds available to pay for the work of the office. The office is repealed effective September 1, 2022, and is scheduled for a sunset review prior to its repeal. The act appropriates $249,454 to the department of local affairs from the implementation of the act. (Note: This summary applies to this bill as enacted.) Read More
Theft - wages - failure to pay wages - paying less than the minimum wage. The act defines wage theft as theft, which is a felony when the theft is of an amount greater than $2,000. The act adds refusing to pay wages or compensation with the intent to coerce a person who is owed wages as conduct that constitutes wage theft. The act removes the exemption from criminal penalties for an employer who is unable to pay wages or compensation because of a chapter 7 bankruptcy action or other court action resulting in the employer having limited control over his or her assets. The act defines "employee" as any person who performs labor or services for the benefit of an employer and provides factors that are relevant for determining whether a person is an employee. The act defines "employer" as having the same meaning as set forth in the federal "Fair Labor Standards Act" and specifically includes foreign labor contractors and migratory field labor contractors or crew leaders in the definition. The act defines intentionally paying a wage less than the minimum wage as theft, which is a felony when the theft is of an amount greater than $2,000. (Note: This summary applies to this bill as enacted.) Read More
Primary care - collaborative created - affordability standards - targets - payment reform recommendations. The act: Establishes a primary care payment reform collaborative in the division of insurance in the department of regulatory agencies; Requires the commissioner of insurance to establish affordability standards for premiums, including adding targets for carrier investments in primary care; and Requires the department of health care policy and financing and carriers who offer health benefit plans to state employees to set targets for investment in primary care.(Note: This summary applies to this bill as enacted.) Read More
Advance directives - health care providers - electronic advance health care directive system - appropriation. The act requires the department of public health and environment (department) to contract with one or more health information organization networks for the creation, administration, and maintenance of a statewide electronic system (system) that allows qualified providers to upload and access advance health care directives. The act defines an advance health care directive as a directive concerning medical orders for scope of treatment, a declaration as to medical treatment, a directive relating to cardiopulmonary resuscitation, or a medical durable power of attorney. The act also requires the department to promulgate rules to oversee the system. The act allows a qualified provider to upload an individual's advanced health care directive upon the request of the individual after the individual has consulted with the qualified provider in person or through telehealth. A qualified provider who uploads an advance health care directive to the system is not subject to criminal or civil liability. The act requires the individual whose medical treatment is the subject of the advance health care directive, or the authorized surrogate decision-maker, to sign an electronic affidavit, prior to uploading the advance health care directive to the system, attesting that the advance health care directive uploaded to the system is appropriately executed, current, and accurate. The act does not allow for any civil or criminal liability or regulatory sanctions for any emergency personnel, health care provider, health care facility, or any other person that complies with a legally executed advance medical directive that is accessed from the system. For the 2019-20 state fiscal year, the act appropriates $993,147 from the general fund to the department of public health and environment for personal services related to health statistics and vital records, operating expenses, and for the purchase of information technology services. (Note: This summary applies to this bill as enacted.) Read More
Professional review committees - knowledge of reporting data - requirement to update information - rules - original source documents - committee membership - requirement to notify medical and nursing board - continuation under sunset law. The act implements the recommendations of the department of regulatory agencies' sunset review and report on the functions of professional review committees as follows: Repeals references to the committee on anticompetitive conduct because the committee no longer exists and replaces the term "utilization and quality control peer review organization" with "quality improvement organization" to be consistent with federal law; Clarifies that governing boards reporting data, and the data reported, to the division of professions and occupations in the department of regulatory agencies or a regulatory board may be known to staff of the division; Requires governing boards to annually update their information with the division; and Requires the division to promulgate rules to determine the information a governing board is required to report and to establish a process to remove governing boards from the registry. The act also: Defines "original source document", exempts such documents from the definition of "records", and specifies when the documents may be subject to subpoena, discovery, or use in a civil action; Encourages each professional review committee of a hospital to appoint a consumer to serve on the committee; and Repeals language requiring, in certain situations, a professional review committee for individuals licensed under the "Colorado Medical Practice Act" or the "Nurse Practice Act" to notify the medical board or nursing board, as applicable. The automatic termination date of the functions of professional review committees is extended until September 1, 2030, pursuant to the provisions of the sunset law. Specified provisions of the act are contingent upon House Bill 19-1172 becoming law. (Note: This summary applies to this bill as enacted.) Read More
Prescription drugs - Canadian prescription drug importation program - federal approval - eligible importers and suppliers - eligible prescription drugs - distribution requirements - reports - rules - appropriations. The act creates the "Canadian Prescription Drug Importation Program" (program) in the department of health care policy and financing (department). On or before September 1, 2020, the department shall submit a request to the United States secretary of health and human services for approval of the program. The department shall begin operating the program not later than 6 months after receiving such approval. The department may expend money for the purpose of requesting approval of the program, but the department cannot spend any other money to implement the program until the department receives approval of the program. Upon receiving approval of the program, the department shall contract with 1 or more vendors to provide services under the program. Each vendor, in consultation with the department and any other vendors, shall establish a wholesale prescription drug importation list (importation list) that identifies the prescription drugs that have the highest potential for cost savings to the state. Each vendor shall revise the list at least annually and at the direction of the department. The department shall review the importation list at least every 3 months to ensure that it continues to meet the requirements of the program. The department may direct a vendor to revise the list, as necessary. Each vendor shall: Identify, in consultation with the department, Canadian suppliers who are in full compliance with relevant Canadian federal and provincial laws and regulations and who have agreed to export prescription drugs identified on the importation list; Verify that such Canadian suppliers meet the requirements of the program and will export prescription drugs at prices that provide cost savings to the state; Contract with such eligible Canadian suppliers, or facilitate contracts between eligible importers and Canadian suppliers, to import prescription drugs under the program; Assist the department in developing and administering a distribution program within the program; Assist the department with the preparation of an annual report and provide any information requested by the department for the report; Ensure the safety and quality of drugs imported under the program; Maintain a list of all eligible importers that participate in the program; Ensure compliance with the federal "Drug Quality and Security Act" by all Canadian suppliers, eligible importers, distributors, and other participants in the program; Provide an annual financial audit of its operations to the department; Provide to the department quarterly financial reports specific to the program, which reports must include information concerning the performance of the vendor's subcontractors and vendors; Submit evidence of a surety bond in an amount of at least $25,000 with any bid or initial contract negotiation documents and maintain documentation of evidence of the surety bond with the department throughout the contract term; and Maintain the information and documentation submitted to the department for at least 7 years. The act imposes certain requirements for drugs that are imported under the program, and the act prohibits certain drugs from being imported under the program. The act states that the following entities are eligible importers under the program: A pharmacist or wholesaler employed by or under contract with a medicaid pharmacy, for dispensing to the pharmacy's medicaid recipients; A pharmacist or wholesaler employed by or under contract with the department of corrections, for dispensing to inmates in the custody of the department of corrections; Commercial plans, as defined by rules promulgated by the medical services board and as approved by the federal government; and A licensed Colorado pharmacist or wholesaler approved by the department. An eligible importer may import a prescription drug from a Canadian supplier if: The drug meets federal food and drug administration standards and is not a controlled substance, biological product, infused or intravenously injected drug, a drug that is inhaled during surgery, or a parenteral drug deemed a threat to public health; and Importing the drug is expected to generate cost savings and would not violate federal patent laws. The act requires the department to designate an office or division that must be a licensed pharmaceutical wholesaler or that shall contract with a licensed pharmaceutical wholesaler. The designated office shall: Set a maximum profit margin so that a wholesaler, distributor, pharmacy, or other licensed provider participating in the program maintains a profit margin that is no greater than the profit margin that the wholesaler, distributor, pharmacy, or other licensed provider would have earned on the equivalent nonimported drug; Exclude generic products if the importation of the products would violate United States patent laws applicable to United States-branded products; Comply with certain federal requirements concerning drug quality and security; and Determine a method for covering the administrative costs of the program. Each participating eligible importer and Canadian supplier shall submit to the vendor specified information about each drug to be acquired by the importer or to be supplied by the Canadian supplier under the program. The department shall immediately suspend the importation of a specific drug or the importation of drugs by a specific eligible importer if it discovers that any drug or activity is in violation of the act or any federal or state law or regulation. The department may revoke the suspension if, after conducting an investigation, it determines that the public is adequately protected from counterfeit or unsafe drugs being imported into this state. The executive director of the department shall promulgate rules as necessary for the administration of the program. The department shall approve a method of financing the administrative costs of the program, which method may include imposing a fee on each prescription pharmaceutical product sold through the program or any other appropriate method determined by the department to finance administrative costs. The department shall not require a fee in an amount that the department determines would significantly reduce consumer savings. On or before December 1, 2021, and on or before December 1 each year thereafter, the department shall submit a report to the governor, the president of the senate, and the speaker of the house of representatives concerning the operation of the program during the previous fiscal year. For the 2019-20 fiscal year, the act appropriates $1,041,802 to the department to implement the act, $134,719 of which is reappropriated to the department of law to provide legal services to the department. (Note: This summary applies to this bill as enacted.) Read More
Adoption assistance program - department of human services - appropriation. The act repeals and reenacts provisions of the state's adoption assistance program (adoption program) that provides cash subsidies and other noncash benefits to families who adopt eligible children and youth who might not otherwise be adopted in order to update the adoption program. The department of human services (state department) supervises the administration of the adoption program by county departments of human or social services (county departments). The act outlines eligibility for the adoption program and the available benefits. Determination of the type and amount of benefits to be provided through the adoption program must take into consideration the circumstances of the adopting family and the needs of the eligible child or youth being adopted. Specific benefits for an adoption made through the adoption program are detailed in a written adoption assistance agreement (agreement). The terms of an agreement are negotiated among all parties involved. The agreement must be reviewed at least every 3 years but may be reviewed sooner at the request of the adoptive parents or the county department. The adoptive parents may appeal any decision made pursuant to the provisions of the adoption program with a hearing before an administrative law judge. The act outlines the conditions under which adoption program subsidies may be suspended or terminated and under which the agreement may be terminated. The state department is required to keep data on the adoption program to help evaluate the adoption program's ongoing effectiveness in providing stability to families involved in the adoption of eligible children and youth. As appropriate, the state department, a county department, or a nonprofit child placement agency is required to provide prospective adoptive families, at the time the family is matched, with information on the various benefits available through the adoption program. For the 2019-20 state fiscal year, the act appropriates: $42,143 from the general fund to the department of human services for information technology services relating to the TRAILS system, and anticipates the receipt of $18,061 in federal funds; and $60,204 from reappropriated funds to the office of the governor, to provide information technology services to the department of human services.(Note: This summary applies to this bill as enacted.) Read More
