Colorado Regulations

All health insurers in Colorado had to complete several attestation forms to qualify as a 2017 health plan. The Carrier Attestation Form requires that plans meet mental health and substance use service essential health benefit requirements. The Carrier Network Adequacy Attestation Form requires that plan’s provider networks contain a sufficient number of mental health, behavioral health, and substance use disorder providers.

The Division of Insurance released a proposed regulation on network adequacy standards and reporting requirements for health plans. Among many things, the proposed regulation defines mental health, behavioral health, and substance use disorder care and providers. To meet the network adequacy standards, plans must meet the following behavioral health requirements:

• 100% of adults must have access to urgent behavioral health,mental health, and substance use disorder care within 24 hours
• 90% of individuals must have access to behavioral health,mental health, and substance use disorder routine, non-urgent, and non-emergency care within 7 calendar days.
• All plans must have a ratio of 1 mental health, behavioral health,and substance use disorder provider per 1,000 patients

The Division of Insurance released a proposed regulation on essential health benefit plan requirements for individual and small group health plans. Among many things, the regulation defines mandated mental health, substance use disorder, and behavioral healthtreatment services in inpatient and outpatient settings. These requirements include covering substance use disorder, mental health, behavioral health benefits, including partial hospitalization and inpatient treatment outside of a hospital, that are equivalent to medical and surgical benefits. Plans must also include outpatienthospital and physician services. This proposed regulation is an update to a 2013 regulation, which did not specify partial hospitalization and inpatient and outpatient settings.

The Division of Insurance released a document titled Rate Filing Procedures for 2017. The goal of the document was to help insurers properly and efficiently submit information needed to show compliance with state and federal law and regulation on rate filing.The document states that the Division of Insurance will compare the application of quantitative treatment limitations and nonquantitative treatment limitations for specific benefits, including mental health, substance use, and behavioral health services. This section is the same as that within Rate Filing Procedures for 2016 and Rate Filing Procedures for 2015.

The Division of Insurance released a document titled Rate Filing Procedures for 2016. The goal of the document was to help insurers properly and efficiently submit information needed to show compliance with state and federal law and regulation on rate filing. The document states that the Division of Insurance will compare the application of quantitative treatment limitations and nonquantitative treatment limitations for specific benefits, including mental health, substance use, and behavioral health services. This section is the same as that within Rate Filing Procedures for 2017 and Rate Filing Procedures for 2015.

The Division of Insurance released a document titled Network Adequacy Filing Procedures for 2016. The goal of the document was to help insurers properly and efficiently submit information needed to show compliance with state and federal law and regulation on network adequacy. Among many things, the document requires insurers to report the number of psychologists, psychiatrists, and social workers who treat mental health and substance use disordersand the number of mental health and substance use disorderfacilities.

The Division of Insurance also provides a table with expected driving distances to mental health practitioners and facilities. Mental health practitioners should be within a 30 mile distance in urban settings and 60 mile distance in rural settings. Mental health facilities should be within a 45 mile distance in urban settings and 90 mile distance in rural settings.

All health insurers in Colorado had to complete an attestation form with many requirements. One of the network adequacy requirements stated that all carriers must attest that they have a sufficient number of providers specializing in mental health and substance use disorder services.

The Division of Insurance released a document titled Rate Filing Procedures for 2015. The goal of the document was to help insurers properly and efficiently submit information needed to show compliance with state and federal law and regulation on rate filing. The document states that the Division of Insurance will compare the application of quantitative treatment limitations and nonquantitative treatment limitations for specific benefits, including mental health, substance use disorder, and behavioral health services. This section is the same as that within Rate Filing Procedures for 2017 and Rate Filing Procedures for 2016.

The Division of insurance released a document titled Network Adequacy Filing Procedures for 2015. The goal of the document was to help insurers properly and efficiently submit information needed to show compliance with state and federal law and regulation on network adequacy. The document highlights that networks must include a sufficient number of mental health and substance use disorder providers.

The Division of Insurance issued a bulletin to plans about annual maximum and annual limits for applied behavior analysis for children with autism. The annual maximums were set at:

• $34,000 for children through age 8
• $12,000 for children age 9 through 19

The annual limits were set at:

• 550 visits for children through age 8
• 185 visits for children age 9 through 19

However, children can receive more than the annual limits if they have not reached the annual maximum for their respective ages.

It is not possible to provide a direct link to the full bulletin because of the design of Colorado’s Insurance Division Website. Please click here and scroll down to B-4.71 and click on that document to read this bulletin.