Insurance - Digest of Bills

Digest of Bills - 2009

INSURANCE

S.B. 09-244 Health insurance - mandated coverage for treatment of autism spectrum disorders in children. Requires all group health benefit plans subject to the jurisdiction of the state insurance commissioner that are issued or renewed on or after July 1, 2010, to cover the assessment, diagnosis, and treatment of autism spectrum disorders (ASD) in children. Defines ASD to include autistic disorder, Asperger's disorder, and atypical autism as a diagnosis within pervasive developmental disorder not otherwise specified.

Directs that treatment for ASD shall be for treatments that are medically necessary, appropriate, effective, or efficient. Lists as treatment for autism spectrum disorders: Evaluation and assessment services, behavior training and behavior management and applied behavior analysis, habilitation or rehabilitative care, pharmacy care and medication, if covered by the health benefit plan, psychiatric care, psychological care, including family counseling, and therapeutic care. States that these listed treatments are not considered experimental or investigational and are considered appropriate, effective, or efficient for the treatment of autism.

Sets an annual maximum benefit cap for applied behavior analysis for ASD at $34,000 for a child from birth through 8 years of age and $12,000 for a child 9 through 18 years of age. For a person who is also covered under the mandate for physical, occupational, and speech therapy for congenital defects and birth abnormalities, allows the level of benefits for physical, occupational, or speech therapy to exceed the limit of 20 visits for each therapy if such therapy is medically necessary to treat ASD.

Requires treatment for ASD to be prescribed or ordered by a licensed physician or licensed psychologist. Defines the professional, educational, and experience requirements for autism services providers that provide direct services.

States that nothing in the statute shall be construed to require or permit a carrier to reduce benefits provided for ASD if a policy already provides coverage that exceeds the requirements of the statute, to prevent a carrier from increasing benefits provided for ASD, or to limit coverage for physical or mental health benefits covered under a health benefit plan. Prohibits a health benefit plan offered to residents of this state providing basic health care services from excluding ASD or imposing additional requirements for authorization of services.

States that coverage for ASD shall not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally under the health benefit plan. Prohibits benefits provided by a carrier for care or treatment of a health condition not diagnosed as ASD from being applied toward any ASD maximum benefit amount established under the policy. States that coverage for ASD is subject to all terms, conditions, definitions, restrictions, exclusions, limitations, and utilization review of health care services that apply to any other coverage under the health benefit plan.

Prohibits a carrier from denying or refusing to provide otherwise covered services, refusing to issue, renew, or reissue, or otherwise restricting or terminating coverage under a policy to an individual because the individual or his or her dependent is diagnosed with ASD or due to utilization of services for which coverage is mandated. Subjects any review of a treatment plan or any appeal of a decision regarding treatment to the rules of the insurance commissioner on prompt investigation of health plan claims involving utilization review and denial of benefits. States that the statute shall not be construed to affect any obligation to provide services to an individual under an individualized family service plan, an individualized education program, or an individualized plan.

Specifies that services for the treatment of ASD are the primary services for a child who is also eligible for early intervention services, and that early intervention services supplement, but do not replace, services provided under the required coverage for ASD.

Excludes group policies from an existing statute that provides that treatment for autism is not mandated and, if covered by a policy, was not to be treated as a mental illness thereby making that statute apply just to individual policies. States that nothing in that statute shall prohibit or prevent a person with ASD from receiving mental health benefits in his or her health benefit plan.

States that the schedule of health care services under the children's basic health plan shall not include the mandated coverage for ASD. Includes a legislative declaration stating that the general assembly finds that due to budgetary issues the state cannot fund an expansion of the children's basic health plan to include a similar coverage for ASD.

APPROVED by Governor June 2, 2009
EFFECTIVE July 1, 2010
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 09-1012 Health insurance - individual and small group plans - wellness and prevention programs - incentives or rewards - information collected by division of insurance - reporting to health care task force. For individual and small group health coverage plans issued or renewed or on after July 1, 2009, authorizes carriers to offer incentives or rewards for covered persons and small groups to participate in wellness and prevention programs (programs). Allows the board of directors of the CoverColorado program or carriers providing health benefit plans to CoverColorado participants to also offer the incentives.

Permits incentives or rewards to include premium discounts or rebates; modifications to copayment, deductible, or coinsurance amounts; or a combination of those incentives. Requires incentives or rewards to be reasonably related to the program and tied to participation in the program rather than to particular outcomes.

Requires programs and incentives or rewards offered by carriers to comply with:

The federal "Health Insurance Portability and Accountability Act of 1996" and related federal regulations; and

The federal "Americans with Disabilities Act of 1990" and state antidiscrimination laws.

Allows carriers to determine the types of programs and incentives to offer as long as:

Participation in the programs is voluntary and is not a condition of coverage;

Incentives or rewards are uniformly applied based on the program, not the size or composition of the small group;

Nonparticipation cannot be penalized;

The participant is not required to achieve a certain outcome in order to receive the incentive; and

The carrier does not market the program so as to induce individuals or small groups to purchase health coverage from the carrier.

Requires the division of insurance to collect and report to the health care task force information regarding wellness and prevention programs offered in the state, including the types of programs offered; the types and nature of incentives or rewards provided; the total number of small groups and individuals participating in programs; and the percentage of carriers offering individual or small group health coverage plans in the state that also offer wellness and prevention programs.

Prohibits a small employer that makes a program available to its employees as part of its small group plan from making participation or disclosure of participation in the program a condition of employment with the small employer.

APPROVED by Governor April 25, 2009
EFFECTIVE July 1, 2009

H.B. 09-1059 Mandatory health insurance coverage - routine patient care during clinical trial or study. Requires all individual and group health benefit plans to provide coverage for routine patient care costs while the covered person participates in a clinical trial or study if the coverage is a benefit that the covered person would receive outside of the clinical trial or study. Requires the clinical trial or study to meet specific standards of approval.

APPROVED by Governor May 2, 2009
EFFECTIVE August 5, 2009
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 09-1102 Health care task force - study - health insurance portability. During the 2009 interim, requires the health care task force to study the portability of health insurance after a policyholder has separated from employment.

APPROVED by Governor April 3, 2009
EFFECTIVE April 3, 2009

H.B. 09-1143 Health insurance plans offered by health maintenance organizations - limited health benefit plans - authority to offer in rural counties - repeal. Allows health maintenance organizations (HMOs) to offer enrollees basic health care services through a limited health benefit plan under the following conditions:

The limited health benefit plan can be offered only to those employer groups that have not offered employer-sponsored health coverage to their employees or all classes of their employees during the prior 12 months;

The limited health benefit plan can be offered only to individuals who have been uninsured for the prior 12 months;

The limited health benefit plan can be offered only in counties with a population that does not exceed 25,000 people;

The limited health benefit plan provides a total annual maximum benefit amount of at least $30,000; and

The HMO counsels enrollees regarding the availability of catastrophic coverage plans that are available in the market.

Requires limited health benefits plans to comply with mandatory coverage requirements and, for plans offered to employer groups, to comply with small group plan requirements and rate regulations.

Requires HMOs offering limited health benefit plans to submit an annual report to the division of insurance detailing information about the enrollment in the plan and the benefits paid under the plan. Requires HMOs to provide enrollees with detailed information regarding limited health benefit plans, including the total annual maximum benefit amount and the consequences of exceeding the total annual maximum benefit amount. Requires enrollees participating in a limited health benefit plan to sign a statement of understanding acknowledging his or her understanding of the contents and limitations of the plan. Repeals the authority of HMOs to offer limited health benefit plans on July 1, 2012.

APPROVED by Governor April 16, 2009
EFFECTIVE August 5, 2009
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 09-1155 Title insurance - justification of new or amended rate - procedures for filing. Requires justification for a new or amended title insurance rate or fee to be filed with the commissioner of insurance, rather than retained at the principal Colorado office of the title insurance company or agent. States that such filing shall include the effective date of the rate or fee, and that the effective date shall be at least 30 days after the commissioner receives the filing.

APPROVED by Governor March 18, 2009
EFFECTIVE August 5, 2009
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 09-1204 Health insurance - mandatory coverage - preventive health care services - prohibition against deductibles or coinsurance. Expands the required coverage for preventive health care services under an individual or group policy or contract providing coverage for health care services issued, delivered, renewed, or reinstated on or after January 1, 2010, to include the following preventive health care services:

Alcohol misuse screening and behavioral counseling interventions for adults by primary care providers;

Cervical cancer screening;

Cholesterol screening for lipid disorders;

Childhood immunizations pursuant to the schedule established by the advisory committee on immunization practices (ACIP);

Influenza vaccinations pursuant to the schedule established by the ACIP;

Pneumococcal vaccinations pursuant to the schedule established by the ACIP; and

Tobacco use screening of adults and tobacco cessation interventions by primary care providers.

Specifies that the coverage is for services provided in accordance with A or B recommendations of the United States preventive services task force (USPSTF).

Prohibits the use of deductibles or coinsurance for covered preventive health care services, but allows the use of copayments for such services.

Modifies the breast cancer screening mandate to specify that health coverage policies are contracts to provide coverage for breast cancer screenings that are recommended pursuant to A or B recommendations of the USPSTF.

APPROVED by Governor June 1, 2009
EFFECTIVE January 1, 2010
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 09-1224 Insurance - health care coverage - individual health benefit plans - rates and benefits - consideration of gender - study by health care task force. Directs the health care task force during the 2009 interim to examine and make recommendations to the general assembly on the issue of health insurance carriers setting the rates and benefits offered for individual health benefit plans based on the gender of the individual insured.

APPROVED by Governor May 18, 2009
EFFECTIVE August 5, 2009
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 09-1338 Insurance laws updates - conformity with federal law. Modifies state insurance laws as follows to comply with recent federal law enactments:

Conforms state law with the federal "Genetic Information Nondiscrimination Act" by expanding the scope of protections, in the areas of health care and medicare supplement insurance coverage, to the use of all genetic information, rather than just information derived from genetic testing;

Conforms state law with the federal "Children's Health Insurance Program Reauthorization Act of 2009" by specifying that a person who loses eligibility under the "Colorado Medical Assistance Act" or the children's basic health plan, or who becomes eligible for premium assistance under such act or plan, is eligible to enroll in his or her employer's group health plan;

Conforms state law with the federal "Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008" by specifying that the mental illness mandate applies only to small group plans and that the state mental health disorder parity law applies to large group plans;

Conforms state law with the federal "Michelle's Law" by prohibiting carriers from terminating dependent coverage for a child under 24 years of age who is enrolled in a post-secondary institution and who takes a medically necessary leave of absence from the institution before the earlier of one year after the first day of the medically necessary leave of absence, or the date the coverage would otherwise terminate under the terms of the plan or health insurance coverage.

Makes the act applicable to policies and contracts issued, delivered, renewed, or reinstated on or after July 1, 2009.

APPROVED by Governor June 1, 2009
EFFECTIVE July 1, 2009

H.B. 09-1349 Health care coverage - continuation after termination from employment - premium subsidy - qualifications - right to elect coverage pursuant to the federal "American Recovery and Reinvestment Act of 2009". Allows an employee who has been terminated from employment the right to continue health care coverage with a 65% premium subsidy if the employee is an assistance-eligible individual. Defines "assistance-eligible individual" as an individual who:

Between September 1, 2008, and February 16, 2009, was continuously insured under the group policy of the employer for at least 6 months prior to termination;

Experienced a qualifying event; and

Is not eligible for health care coverage under another group plan or under medicare.

Defines "qualifying event" to mean an involuntary termination from employment that does not include the death of the employee, divorce or legal separation from the employee, or the loss of dependent status.

Requires an employer to provide notice to qualified beneficiaries of the right to elect coverage that includes eligibility and other information pursuant to the federal "American Recovery and Reinvestment Act of 2009".

Applies the act to employers who employ employees on at least 50% of its working days or, if the employer was not in business for the entire preceding calendar year, on at least 50% of its working days in the preceding calendar quarter.

APPROVED by Governor June 1, 2009
EFFECTIVE June 1, 2009

H.B. 09-1364 Health care task force - membership - length of terms. Increases the length of terms that members appointed to the health care task force serve from one year to 2 years.

APPROVED by Governor June 1, 2009
EFFECTIVE June 1, 2009