Benefits to explicitly include services to address substance use disorder and mental health
DENVER - Today, the Centers for Medicare & Medicaid Services (CMS), announced it has approved the Colorado health insurance plan that will set the minimum health care coverage requirements starting in 2023. The plan establishes the essential health benefits (EHBs) within Colorado for individual plans (meaning not from an employer) and small group plans (for small employers with less than 100 employees).
CMS Administrator Chiquita Brooks-LaSure and Deputy Administrator Dr. Ellen Montz joined Governor Jared Polis, Lieutenant Governor Dianne Primavera, Colorado Insurance Commissioner Michael Conway and Senator Brittany Pettersen to announce the approval at the Governor's Residence at the Boettcher Mansion.
“This is a great day for health care in Colorado. This plan expands access to mental health services for Coloradans while helping those fighting substance abuse to overcome their addiction,” said Governor Jared Polis. “This improves care for Coloradans and ensures that even more Coloradans have access to help when they need it. I thank Administrator Brooks-LaSure and her team for recognizing Colorado’s bold initiative taking on addiction and providing help.”
Colorado’s new 2023 plan will address substance use disorder (SUD) by expanding the number of drugs that insurance companies are required to cover in their prescription drug formularies as alternatives to opioids, as well as adding acupuncture treatments. The new plan adds 15 drugs as alternatives and will cover up to six acupuncture visits per year.
The plan also includes an annual mental health wellness exam -- one 45-60-minute visit per plan year, with a qualified mental health care provider. This visit can include services such as behavioral health screening, education and consultation about healthy lifestyle changes, referrals to ongoing mental health treatment, and the discussion of potential medication options.
The Polis-Primavera administration is committed to ensuring all Coloradans have access to mental health services. This past legislative session, Governor Polis was proud to sign several state stimulus measures that direct over $9 million towards expanding access to mental health services for Colorado’s youth and individuals who lost their jobs during the pandemic. Additionally, Governor Polis signed legislation that creates the Behavioral Health Administration, as recommended by the Behavioral Health Taskforce, which will provide leadership and help to unify and streamline our state’s behavioral health system and the bipartisan SB21-137 which appropriated $95,800,000 for various behavioral health programs and services.
“I am proud that Colorado continues to lead the nation in healthcare and health insurance reform,” said Lieutenant Governor and Director of the Office of Saving People Money on Health Care Dianne Primavera. “Our Administration, including the Office of Saving People Money on Health Care and Commissioner Conway and the Division of Insurance, is dedicated to making access to high-quality, affordable, equitable care a reality for all Coloradans. Today’s announcement means that gender diverse Coloradans can stop guessing at how and which gender-affirming benefits are included in their coverage.”
“We’ve made great strides in making health insurance more affordable in Colorado, but this is a huge step in making sure the benefits in that insurance are more inclusive and meaningful,” said Colorado Insurance Commissioner Michael Conway. “The benefits included in the new plan for 2023 will be included in all individual and small group health plans, including the Colorado Option plans, which come online that same year.”
“Today’s announcement is an exciting step that furthers Colorado’s investments in the state’s behavioral health and substance use disorder prevention programs that ensures access to these critical services is affordable and accessible for all. The pandemic has taken a toll on all of us and as Colorado rebounds, improving these services will go a long way in making every Coloradan healthier and happier,” said Senator Brittany Pettersen.
In addition, Colorado is the first state in the country to explicitly include gender-affirming care services in its plan (“Gender-affirming care” is another way of describing the mental and physical health services that help align a transgender person’s body into alignment with their gender identity.). These will be comprehensive services that insurance companies cover for individuals and small group plans starting in 2023. Currently, all insurance companies must cover some form of gender-affirming care. However, coverage varies greatly by insurance company, and is not always comprehensive and may include explicit exclusions for certain services, even if a health care provider determines a service to be medically necessary.
Plan Evaluation Process
Early in 2021, the Division of Insurance (DOI) convened a volunteer workgroup to advise in the evaluation of the State’s health insurance plan and proposed changes. The DOI held stakeholder meetings to determine benefits that should be added or removed from the plan. Participants in these stakeholder meetings included consumer advocates, insurance companies, consumers, health care providers, and any interested members of the public. All meetings were open to the public, and a public comment period allowed for input beyond the meetings.
The DOI submitted the proposed plan to CMS in May. Colorado last updated its plan in 2015 for the 2017 plan year. Find more information about this process, including the materials and information submitted to CMS, at the Division’s website, ACA - Benchmark Health Insurance Plan Selection.
View today’s announcement