The act requires insurance carriers to provide coverage for the treatment of substance use disorders in accordance with the American society of addiction medicine (ASAM) criteria for placement, medical necessity, and utilization management determinations in accordance with the most recent edition of the ASAM criteria. The act also authorizes the commissioner of insurance, in consultation with the department of human services (DHS) and the department of health care policy and financing, to identify by rule alternate nationally recognized substance-use-disorder-specific treatment criteria if the ASAM criteria are no longer available, relevant, or reflect best practices. These provisions apply to health benefits plans issued or renewed on or after January 1, 2022.
The act prohibits managed service organization contracted providers; withdrawal management services; and recovery residences from denying access to medical or substance use disorder treatment services, including recovery services, to persons who are participating in prescribed medication-assisted treatment for substance use disorders. In addition, the act prohibits courts and parole, probation, and community corrections from prohibiting the use of prescribed medication-assisted treatment as a condition of participation or placement.
The act requires managed care entities to provide coordination of care for the full continuum of substance use disorder and mental health treatment and recovery services, including support for individuals transitioning between levels of care.
The act authorizes the commissioner of insurance, in consultation with the department of public health and environment (CDPHE), to promulgate rules, or to seek a revision of the essential health benefits package, for prescription medications for medication-assisted treatment to be included on insurance carriers' formularies.
The act requires insurance carriers to report to the commissioner of insurance on the number of in-network providers who are licensed to prescribe medication-assisted treatment for substance use disorders, including buprenorphine, and the number of prescriptions for medication-assisted treatment filled by enrollees. Further, insurance carriers shall report on the carrier's efforts to ensure sufficient capacity for and access to medication-assisted treatment. The act requires the commissioner of insurance to promulgate rules concerning the reporting.
The act requires insurance carriers to provide coverage for at least one opiate antagonist.
The act consolidates part 1 of article 82 of title 27, Colorado Revised Statutes, relating to emergency treatment and voluntary and involuntary commitment of persons for treatment of drugs into the existing part 1 of article 81 of title 27 relating to emergency treatment and voluntary and involuntary commitment of persons for treatment of alcohol use disorders, in order to create a single process that includes all substances. The new scope of part 1 of article 81 of title 27 includes both alcohol use disorder and substance use disorder under the defined term "substance use disorder".The amendments and additions to part 1 of article 81 of title 27 include:
- Defining "administrator" to include an administrator's designee;
- Adding a definition of "incapacitated by substances" to include a person who is incapacitated by alcohol or incapacitated by substances;
- Changing terminology throughout that refer to "substances" to include both alcohol and drugs;
- Adjusting the duration of the initial involuntary commitment from 30 days to up to 90 days;
- Allowing a person to enter into a stipulated order for committed treatment, expediting placement into treatment;
- Removing the mandatory hearing for the initial involuntary commitment but allowing a person to request a hearing if the person does not want to enter into a stipulated order for committed treatment;
- Incorporating in statute "patient's rights" relating to civil commitment;
- Using person-centered language throughout the statutory process; and
- Relocating the existing opioid crisis recovery funds advisory committee from article 82 in title 27 to article 81 in title 27.
In addition, the act amends statutory references, including several in the professional licensing statutes in title 12, Colorado Revised Statutes, to remove references to both alcohol use disorder and substance use disorder as grounds for professional discipline, and replaces those terms with the single term "substance use disorder", which the act now defines in article 81 of title 27 to include both drugs and alcohol. The act also amends statutory references to provisions in part 2 of article 82 of title 27, which the act repeals and replaces those references with a new reference to the relevant provisions in article 81 of title 27.
(Note: This summary applies to this bill as enacted.)