Treatment for Substance Use Disorders

The act prohibits an insurance carrier that provides coverage for a drug used to treat a substance use disorder under a health benefit plan from requiring prior authorization for the drug based solely on the dosage amount.

The act requires an insurance carrier to reimburse a licensed pharmacist prescribing or administering medication-assisted treatment (MAT) pursuant to a collaborative pharmacy practice agreement (collaborative agreement) at a rate equal to the reimbursement rate for other health-care providers. The act amends the practice of pharmacy to include prescriptive authority for any FDA-approved product indicated for opioid use disorder in accordance with federal law, if authorized through a collaborative agreement. The act requires the state board of pharmacy, the Colorado medical board, and the state board of nursing to develop a protocol for pharmacists to prescribe, dispense, and administer certain FDA-approved products for MAT. The act requires reimbursement to pharmacies of an enhanced dispensing fee for administering injectable antagonist medication for MAT that aligns with the administration fee paid to a provider in a clinical setting. The act requires the medical assistance program to reimburse a pharmacist prescribing or administering medications for opioid use disorder pursuant to a collaborative agreement at a rate equal to the reimbursement rate for other providers.

The act authorizes licensed clinical social workers, marriage and family therapists, and licensed professional counselors (professionals) within their scope of practice to provide clinical supervision to individuals seeking certification as addiction technicians and addiction specialists, and directs the state board of addiction counselors and the state board of human services, as applicable, to adopt rules relating to clinical supervision by these professionals. Further, a licensed addiction counselor is authorized to provide clinical supervision to individuals seeking licensure as marriage and family therapists or professional counselors if the licensed addiction counselor has met the education requirements for those professions, or the equivalent, as determined by the respective boards regulating those professions.

The act expands the medication-assisted treatment expansion pilot program to include grants to provide training and ongoing support to pharmacies and pharmacists who are authorized to prescribe, dispense, and administer MAT pursuant to a collaborative agreement or drug therapy protocol to assist individuals with a substance use disorder.

The act requires the department of health care policy and financing (HCPF) to seek federal authorization to provide MAT, case management services, and a 30-day supply of prescription medication to medicaid members upon release from jail or a juvenile institutional facility.

The act adds substance use disorder treatment to the list of health-care or mental health-care services that are required to be reimbursed at the same rate for telemedicine as a comparable in-person service.

The act requires HCPF to seek federal authorization to provide partial hospitalization for substance use disorder treatment with full federal financial participation.

The act requires each managed care entity (MCE) that provides prescription drug benefits or methadone administration for the treatment of substance use disorders to:

• Set the reimbursement rate for take-home methadone treatment and office-administered methadone treatment at the same rate; and
• Not impose any prior authorization requirements on any prescription medication approved by the FDA for the treatment of substance use disorders, regardless of the dosage amount.

The act requires the behavioral health administration (BHA) to collect data from each withdrawal management facility on the total number of individuals who were denied admittance or treatment for withdrawal management and the reason for the denial and to review and approve any admission criteria established by a withdrawal management facility.

The act requires each MCE to disclose the aggregated average and lowest rates of reimbursement for a set of behavioral health services determined by HCPF and authorizes behavioral health providers to disclose reimbursement rates paid by an MCE to the behavioral health provider.

Beginning in the 2024-25 state fiscal year, the act appropriates $150,000 from the general fund to the Colorado child abuse prevention trust fund (trust fund) for programs to reduce the occurrence of prenatal substance exposure. For the 2024-25 and 2025-26 state fiscal years, the act also annually appropriates $50,000 from the general fund to the trust fund to convene a stakeholder group to identify strategies to increase access to child care for families seeking substance use disorder treatment and recovery services.

The act requires the BHA to contract with an independent third-party entity to provide services and supports to behavioral health providers seeking to become a behavioral health safety net provider with the goal of the provider becoming self-sustaining.

The act creates the contingency management grant program in the BHA to provide grants to substance use disorder treatment programs that implement a contingency management program for individuals with a stimulant use disorder.

The act authorizes the BHA to apply for federal funding for fetal alcohol spectrum disorder programs and to receive and disburse federal funds to public and private nonprofit organizations.

The act extends the opioid and other substance use disorders study committee until September 1, 2026.

The act appropriates money to implement the act.

APPROVED by Governor June 6, 2024

PORTIONS EFFECTIVE August 7, 2024

PORTIONS EFFECTIVE July 1, 2025
(Note: This summary applies to this bill as enacted.)