{"id":31027,"date":"2026-03-12T00:00:00","date_gmt":"2026-03-12T04:00:00","guid":{"rendered":"https:\/\/www.resourcepro.com\/bulletin\/new-co-regulation-expands-behavioral-health-coverage-and-protects-patient-access\/"},"modified":"2026-04-01T06:50:23","modified_gmt":"2026-04-01T10:50:23","slug":"new-co-regulation-expands-behavioral-health-coverage-and-protects-patient-access","status":"publish","type":"bulletin","link":"https:\/\/www.resourcepro.com\/bulletin\/new-co-regulation-expands-behavioral-health-coverage-and-protects-patient-access\/","title":{"rendered":"New CO Regulation Expands Behavioral Health Coverage and Protects Patient Access"},"content":{"rendered":"\n<p><strong>CO<\/strong>| <strong><a href=\"https:\/\/drive.google.com\/file\/d\/1u3qareHIrKhha4Nlftj2cTbu9f6djKGZ\/view\" target=\"_blank\" rel=\"noreferrer noopener\">Colorado Amended Regulation 4-2-64<\/a><\/strong> <span style=\"text-decoration: underline;\">sets comprehensive standards to ensure full parity between behavioral health (including mental health and substance use disorders) and medical\/surgical benefits in Colorado health benefit plans,<\/span> by defining required behavioral health coverage (including preventive services, court-ordered treatment, ASAM-based SUD care, eating disorder standards, and network access), aligning financial requirements and treatment limitations with federal MHPAEA rules, imposing strict comparability and data-driven oversight of nonquantitative treatment limitations (e.g., prior authorization, network design, utilization review), and establishing detailed annual filing, reporting, documentation, and confidentiality requirements for carriers, with <em><strong>e<\/strong><\/em><strong>nforcement provisions and an effective date of May 15, 2026.<\/strong><\/p>\n\n\n\n<p><strong><span style=\"text-decoration: underline;\">Key Issues: <\/span><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Benefit design and coverage mandates<\/strong> \u0096 carriers must cover specified behavioral health preventive services, court-ordered treatment, medication-assisted treatment without PA or step therapy, meaningful MH\/SUD benefits in every classification where medical\/surgical is covered, and may not use BMI\/IBW-based criteria for eating disorder medical necessity.<\/li>\n\n\n\n<li><strong>Parity in limitations and management<\/strong> \u0096 financial requirements, quantitative and nonquantitative treatment limitations (including utilization review, medical necessity criteria, formulary design, and network composition) for MH\/SUD cannot be more restrictive than those applied to substantially all comparable medical\/surgical benefits, and must be designed and applied using comparable factors, evidentiary standards, and ongoing outcome data analysis to detect and correct material access differences.<\/li>\n\n\n\n<li><strong>Extensive carrier reporting and accountability<\/strong> \u0096 carriers must annually submit attestations, quantitative treatment limitation classifications, and a suite of NQTL and network-related templates (utilization review, out-of-network use, provider engagement, ASAM usage, eating disorder criteria, pharmacy management, and a six-step NQTL comparative analysis), with specified signatures, SERFF filing structure, confidentiality handling, and are subject to sanctions, including fines and license actions, for noncompliance.<\/li>\n<\/ul>\n\n\n\n<p><strong><em><a href=\"https:\/\/drive.google.com\/file\/d\/1u3qareHIrKhha4Nlftj2cTbu9f6djKGZ\/view\" target=\"_blank\" rel=\"noreferrer noopener\">Click here to see CO Amended Regulation 4-2-64<\/a><\/em><\/strong><\/p>\n\n\n\n<p><\/p>\n","protected":false},"featured_media":21492,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"department":[252],"state":[270],"class_list":["post-31027","bulletin","type-bulletin","status-publish","format-standard","has-post-thumbnail","hentry","department-department-of-insurance","state-colorado"],"acf":[],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/www.resourcepro.com\/wp-json\/wp\/v2\/bulletin\/31027","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.resourcepro.com\/wp-json\/wp\/v2\/bulletin"}],"about":[{"href":"https:\/\/www.resourcepro.com\/wp-json\/wp\/v2\/types\/bulletin"}],"version-history":[{"count":1,"href":"https:\/\/www.resourcepro.com\/wp-json\/wp\/v2\/bulletin\/31027\/revisions"}],"predecessor-version":[{"id":31109,"href":"https:\/\/www.resourcepro.com\/wp-json\/wp\/v2\/bulletin\/31027\/revisions\/31109"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.resourcepro.com\/wp-json\/wp\/v2\/media\/21492"}],"wp:attachment":[{"href":"https:\/\/www.resourcepro.com\/wp-json\/wp\/v2\/media?parent=31027"}],"wp:term":[{"taxonomy":"department","embeddable":true,"href":"https:\/\/www.resourcepro.com\/wp-json\/wp\/v2\/department?post=31027"},{"taxonomy":"state","embeddable":true,"href":"https:\/\/www.resourcepro.com\/wp-json\/wp\/v2\/state?post=31027"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}