(1) An individual or group health benefit plan delivered or issued for delivery within this state by an entity subject to the provisions of part 2, 3, or 4 of this article 16 that provides coverage for behavioral, mental health, or substance use disorder services must provide coverage for behavioral, mental health, or substance use disorder services regardless of whether the services are voluntary or court-ordered as a result of contact with the criminal justice or juvenile justice system. The health benefit plan is required to provide coverage only for benefits that are medically necessary and otherwise covered under the plan. Such coverage is subject to applicable in- or out-of-network copayment, deductible, and policy maximums and limitations. The court order for behavioral, mental health, or substance use disorder services must not mandate the type of behavioral, mental health, or substance use disorder services or the length and frequency of treatment that is to be covered by the health benefit plan. The health benefit plan is only responsible for those benefits that are covered by the health benefit plan and not those that are court-ordered that exceed the scope of benefits as provided by the health plan. Determination of medically necessary behavioral, mental health, or substance use disorder services must be made by the health benefit plan based on the submitted clinical treatment plan from a provider who is designated by and affiliated with the health benefit plan. Health benefit plans issued by an entity subject to the provisions of part 4 of this article 16 may provide that the benefits required pursuant to this section are covered benefits only if the services are deemed medically necessary and are rendered by a provider who is designated by and affiliated with the health maintenance organization.
Nothing in this section mandates or is meant to construe that a health benefit planprovide coverage for behavioral, mental health, or substance use disorder services.
For purposes of this section, "behavioral, mental health, or substance use disorderservices" includes the prevention of, screening for, and treatment of behavioral, mental health, or substance use disorders as described in section 10-16-104 (5.5).
For purposes of this section, "behavioral, mental health, or substance use disorderservices" does not include services that are outside the scope of the contract. Such behavioral, mental health, or substance use disorder services that are outside the scope of the contract may include: Services that are custodial or residential in nature, probation assessments, testing for ability, aptitude, or intelligence, or performing evaluations, such as placement evaluations, custody evaluations, reunification assessments, or community risk assessments for any purpose other than treatment of behavioral, mental health, or substance use disorders.
Source: L. 2006: Entire section added, p. 159, § 1, effective March 31. L. 2013: (3) amended, (HB 13-1266), ch. 217, p. 988, § 47, effective May 13. L. 2017: Entire section amended, (SB 17-242), ch. 263, p. 1265, § 37, effective May 25. L. 2019: (3) amended, (HB 191269), ch. 195, p. 2128, § 4, effective May 16.
Cross references: (1) For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.
(2) For the short title ("Behavioral Health Care Coverage Modernization Act") in HB 191269, see section 1 of chapter 195, Session Laws of Colorado 2019.