Colorado

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
• autism (effective January 1, 2017)

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”

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”