CMS Announces Approval of Colorado Assurance Plan to Expand EHBs – State of Reform

The Centers for Medicare & Medicaid Services (CMS) announcement the approval of the minimum health coverage 2023 Colorado Benchmark Health Insurance Plan Tuesday. The plan sets the minimum standards for Essential Health Benefits (EHB) in Colorado for small group plans — for employers with fewer than 100 employees — and individual plans.

The plan expands covered care to include mental health wellness reviews, expanded drug formularies for opioid alternatives, and gender-affirming care.

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Governor Jared Polis said:

“This is a great day for health care in Colorado. This plan expands access to mental health services for Coloradans while helping those who struggle with addiction overcome their addiction. It improves care for Coloradans and ensures that even more Coloradans have access to help when they need it.

The Colorado Division of Insurance (DOI) held meetings with stakeholders, consultants, insurance companies and advocates to create this plan for CMS, which was submitted in May 2021. DOI meetings were open to public and included a public comment period for comments beyond the scheduled meetings.

The mental health wellness exams included are one-time visits of approximately 45-60 minutes per plan per year. These visits will serve as a mental health screening and provide a warm transfer to ongoing mental health treatment. The visit may also include lifestyle choice consultations, behavioral health screenings, and discussions about potential medication options.

These wellness reviews have been added to the plan approved by Internal Bill 21-1068, which requires health plans to cover an annual mental health wellness exam after confirmation from the U.S. Department of Health and Human Services. Large employer plans are required to institute these reviews by January 1, 2022, and small group and individual plans must do so by January 1, 2023.

The approved plan also includes extensions of drugs that insurance companies are required to cover in formularies to include alternatives to opioids for pain management. The plan adds 12 medications and will cover up to six acupuncture visits per year.

These measures are intended to address substance abuse disorders, opioid use disorders, and opioid overdose deaths in Colorado. According to the Colorado Health Access Survey (CHAS) of the Colorado Health Institute (CHI), 11.9% of people over the age of 18 suffer from substance abuse in Colorado, 4.2% more than the national average. In Colorado, 564 opioid overdose deaths were reported in 2018, according to the National Institute on Drug Abuse.

Senator Brittany Pettersen, who was ardent defender for substance use disorder in the Legislative Assembly, said:

“Today’s announcement is an exciting step that reinforces Colorado’s investments in the state’s behavioral health and substance abuse prevention programs, which ensure access to these essential services is affordable and accessible to all.The pandemic has taken a toll on all of us, and as Colorado rebounds, improving these services will go a long way toward making every Coloradon healthier and happier.

With this approval, Colorado became the first state in the nation to explicitly include gender-affirming comprehensive care services in its plan. Gender-affirming care is the mental and physical health services provided to help align a transgender person’s body with their gender identity. Currently, coverage varies widely between insurance companies, may not be comprehensive, or excludes certain gender affirmation services. Lieutenant Governor Dianne Primavera said:

“Today’s announcement means gender-diverse Coloradans can stop guessing how and what gender-affirming benefits are included in their coverage.”

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